Image of iron accumulation (in blue) consistent with hemochromatosis in liver cells. Hemochromatosis is an iron overload that can become toxic and cause organ failure, affecting service members’ readiness (Photo “Hemochromatosis liver iron Prussian blue”, by Joseph Mathew, May Y Leong, Nick Morley, and Alastair D Burt, licensed under CC BY 2.0.)
"Other symptoms include early onset Type 2 diabetes or cardiac irregularities, including arrhythmias and heart failure," said the gastroenterologist. If detected after significant liver damage has occurred, "patients can develop cirrhosis and complications related to this condition, including fluid in the abdomen, confusion or altered mentation, or throwing up blood from the rupture of large veins in the esophagus."
Horn explained iron can also increase the aggressiveness of certain bacterial species, resulting in patients becoming more susceptible to certain bacterial infections.
"Bacteria which are more common with hemochromatosis include Yersinia enterocolitis, resulting in right lower quadrant abdominal pain, fever, vomiting, and diarrhea, or Vibrio vulnificus (transmitted by eating undercooked seafood), resulting in a severe systemic bacterial infection or severe skin infections," he said.
Treatment
The Centers for Disease Control and Prevention say the earlier hemochromatosis is diagnosed, the less likely patients are to develop serious complications, which could cause permanent problems.
Horn emphasized that screening is important because of the number of possible complications that can occur due to continued, unregulated iron overloads. All it takes is a blood test to determine iron levels.
"If [the test results are] abnormal, a genetic screen can be performed to evaluate for abnormal genes that are associated with the condition," he said.
If the screenings reveal elevated iron levels, patients can start treatment to prevent the major complications of the disease. Occasionally, a liver biopsy may be required to confirm the diagnosis of hemochromatosis and determine the extent of the disease.
Hemochromatosis is curable with a liver transplant, but due to the limited availability of livers for transplantation, this procedure is reserved for patients who have end-stage liver disease or liver cancer, said Horn. "The majority of hemochromatosis patients will need to be treated throughout their life to maintain normal iron levels and prevent complications."
According to the National Institutes of Health, patients diagnosed with hemochromatosis can treat it with regularly scheduled blood removal - known as phlebotomy - as well as changes in diet, and medication to lower the amount of iron in their body.
However, "the first line of treatment for hemochromatosis is phlebotomy," said Horn.
Since almost two-thirds of the body's iron is found in the hemoglobin within red blood cells, removing blood decreases the amount of iron in the body. But patients who are not tolerant to phlebotomy can opt for medications that have the same effect.
"They bind to excess iron in the body and excrete it in the urine or feces," he said.
Additionally, donating blood is a good way to remove excess iron from the body while also providing blood to another individual who could use the blood, said Horn. The Armed Services Blood Program is mission critical and has Joint Blood Program Officers within each Combatant Command to support the global blood mission.
Effect on readiness
Horn stated that most active-duty service members with hemochromatosis will not have any symptoms when they're young, but older active-duty troops may start to experience symptoms from uncontrolled hemochromatosis.
"When hemochromatosis is identified in a young soldier, it's important they start treatment as soon as there is evidence of iron overload," said Horn. "This will require multiple sessions of phlebotomy, which may prevent them from deployment, until their iron levels are better controlled."
Since they will continue to require periodic lab tests and phlebotomy sessions every few weeks to months, they will need to be stationed at a base with those capabilities, he said.
"As long as their iron levels are controlled, and they have no evidence of advanced disease related to hemochromatosis, they can be deployed to locations that have laboratory and phlebotomy capabilities," said Horn.