Posted on: Saturday, October 23, 2004

PRESCRIPTIONS
Bloodletting aids iron overload

By Landis Lum

Q. My husband had joint pains, fatigue, and mild liver test elevations, and his doctor diagnosed hemochromatosis. What is this?

A. Hemochromatosis is a condition of iron overload caused by too much iron being absorbed from food because of an inherited defect in the genes directing iron absorption by the cells of the intestines. Because the body can't get rid of excess iron, it is stored in various glands and muscle, such as the liver, pancreas and heart. Over the years, these tissues may get damaged.

Hemochromatosis occurs in 1 in 200 people — less often in women and in Asians. It is more common in men than women.

If undiagnosed, it can occasionally lead to heart failure, cirrhosis, and even liver cancer. Arthritis doesn't occur in everyone, but may cause pain in the mid-finger joints, the second and third knuckles, and the knees, back and neck.

Weakness is the most common symptom, though hemochromatosis can also cause abdominal pain, impotence, loss of sexual desire, liver enlargement, or skin pigmentation (a bronze color). Mild liver test abnormalities occur in 65 percent of patients.

Symptoms usually start in men between the ages of 30 and 50 and in women after age 50. The diagnosis begins with a blood test — morning fasting iron studies.

Guess what the treatment is?

Bloodletting, where about half a liter of blood is removed every week to get rid of excess iron. Started early, this can prevent organ damage and improve survival, and after 2 to 3 years, can be reduced to 3 to 4 times a year. An iron-poor diet alone won't work.

Interestingly, iron deficiency can also cause fatigue — from anemia and, in some cases, from restless-legs syndrome — uncomfortable feelings in the legs, especially at night, which makes you move them or makes you want to move them, leading to insomnia.

(I wrote about restless legs syndrome and its treatments in my June 19 Prescriptions column.)

But iron deficiency causes only some cases of restless-legs syndrome, and drugs may be necessary to control this common ailment.

My favorites are Mirapex and Requip, but if you have a distressing desire to move your legs while just resting or sitting, talk to your doctor to see what's best for you. And don't forget the iron studies. For more information on restless-legs syndrome or hemochromatosis (or any health topic for that matter), go to medlineplus.gov on the Internet. Click in the blank space at top left and type the words "restless legs" then click on "Search MedlinePlus," then click on any of the titles under "Health Topics."

There are a lot of unreliable medical sources on the Internet, but medlineplus.gov is excellent.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.