Hemochromatosis is treated by blood removal

Dear Dr. Roach: My 50-year-old, active son-in-law became very fatigued a year and half ago. He initially was diagnosed with low testosterone and given further testing. Finally, about six months from the onset of his symptoms, he was diagnosed with hemochromatosis, with iron levels in the 600s. Consequently, one and a half pints of blood have been withdrawn weekly for about two months. Levels are now in the 500s. His organs all have been tested for damage, but only two benign tumors have been found, in his kidneys. Despite treatment, the fatigue has continued. Is there anything else he should be doing? — M.F.

ANSWER: Hemochromatosis is a disease of iron metabolism. In hereditary hemochromatosis, the body absorbs as much iron as it can, even if it doesn't need it, and the iron builds up in various tissues in the body. The organ systems most commonly affected are the bone marrow, heart and liver; however, many other organs will be affected if the disease is not treated. Low testosterone is common in hemochromatosis, and it might have been a clue in such a young man.

Men tend to be affected at a younger age than women, as women are protected to a certain extent by menstruation, but young women certainly can have asymptomatic or even symptomatic disease.

Fatigue in hemochromatosis can have several causes, but the most worrisome is iron overload in the heart, which can cause heart failure. He probably should have an echocardiogram if his doctors have not already done one. Fatigue is common and does not need to be heart-related. In my experience, fatigue often gets better with treatment of the iron overload, which can take a year or more to successfully return to normal.