Bronze skin, diabetes, cirrhosis, arthropathy, cardiomyopathy
Calculators: meld child
Best initial: ↑Transferrin saturation (>45%, often >80%) + ↑ferritin
Confirm: HFE gene (C282Y) / liver MRI
Treat: Serial phlebotomy; deferoxamine/deferasirox if unable to phlebotomize
Order set Transferrin saturation + ferritin HFE genotype LFTs, glucose Liver imaging ± biopsy if ferritin very high Criteria Admit Decompensated liver/cardiac disease
Discharge Venesection plan, screening of relatives, surveillance
Clinical detail — differentials, red flags, pitfalls, disposition Red flags Cirrhosis Cardiomyopathy Diabetes Differentials Secondary iron overload NAFLD Alcoholic liver disease Common mistakes Missing family screening Attributing ↑ferritin to inflammation only Disposition & follow-up Venesection; screen relatives; HCC surveillance if cirrhotic.
Discharge package Medications —
Follow-up Venesection programme; HCC surveillance if cirrhotic
Lifestyle Avoid alcohol, iron/vitamin-C supplements
Warning symptoms Jaundice, abdominal swelling, heart symptoms
💊 Treatment detail — doses & preparation Weekly venesection definitive
Dose 450 mL blood removed weekly until ferritin <50 µg/L, then maintenance 3–4×/yr
Preparation Large-bore needle, 15 min
Monitor Ferritin + transferrin saturation q3 mo
Deferasirox iron chelator
Dose 10–30 mg/kg OD (transfusion overload)
Preparation 90–360 mg tablets on empty stomach
Monitor Creatinine, LFTs monthly; GI upset, rash
📖 AASLD Haemochromatosis Reviewed July 2026