Testing for hemochromatosis not needed for everyone
DEAR DR. ROACH: I am 64 years old and was diagnosed with hereditary hemochromatosis several years ago, following an enhanced annual physical exam that my company provides. My condition is now successfully managed through regular phlebotomies, or blood-letting. I consider myself very lucky, as I understand that many people with hemochromatosis are either misdiagnosed or diagnosed too late, and as a result end up developing serious and sometimes fatal diseases, including liver cirrhosis, heart disease, diabetes, various types of cancer or arthritis. I also understand that hemochromatosis is a relatively common genetic disorder, especially among those of Northern European descent, and that a simple blood test for ferritin and transferrin saturation generally can lead to early detection of the condition (as it did in my case). Should there not be more widespread screening for hemochromatosis among atrisk populations, given that it is relatively common, easily treated and can lead to so much unnecessary suffering or even death if it goes undiagnosed? — S.M.
ANSWER: Hereditary, or primary, hemochromatosis prevents the body from regulating absorption of iron. Normally, the body absorbs all the iron it can when body stores are low and very little when body stores are adequate, but in hereditary hemochromatosis, the body absorbs maximally all the time, leading to iron overload. This may affect multiple organs, including liver, heart, bone marrow and joints.
The policymakers who decide whether to recommend population-level screening have recommended against screening for hereditary hemochromatosis, based on the rarity of people who will develop symptoms of hemochromatosis. Even among people with the gene for hemochromatosis, development of overt disease is only in a subset of those with the highest-risk gene mutation.
However, this recommendation does NOT apply to family members of people with hereditary hemochromatosis, who should be screened. Also, clinicians should know to look for hemochromatosis in people with vague symptoms, such as fatigue, joint pain or skin-color darkening. The condition may be looked for by either genetic testing, or by transferrin saturation, which is the iron level in the blood divided by the “total iron binding capacity.” Ferritin levels are high only in iron overload, which most often happens earlier in men than in women.
DEAR DR. ROACH: Few things are more satisfying on a cold winter night than a nice warm bed with an electric blanket. I am concerned about the electromagnetic waves emitted from the wiring in the blanket. Should I be worried? — D.A.
ANSWER: This is a controversial area, but I think the best answer probably is that you do not have to be worried. It is true that electric blankets, like all electrical devices that run a current, generate magnetic and electrical fields, and that these fields can penetrate body tissues. However, the majority of research in the area finds no increase in risk of disease, especially cancer, from exposure to these low-level electromagnetic fields.
I have seen burns from electric blankets that have become worn, and older electric blankets lack automatic turn-offs and other safety features of newer blankets. I would recommend replacing an old electric blanket. Also, I don’t recommend any kind of heating device for people with damage to nerves, especially diabetic neuropathy.
People who remain concerned about the harm of EMFs can either use the blanket to warm up the bed and then turn it off, or buy a lowvoltage electric blanket, which produces much-lower-strength EMFs.