Too much iron treated by regular blood donations

DEAR DR. ROACH >> I’m a 70-yearold woman. Last October, during my annual physical, blood tests showed that my iron levels were extremely high. My doctor did additional blood tests for hemochromatosis and concluded that I didn’t have it. She suggested that I donate blood every three months to keep the iron levels down, which I have been doing for a year. Every time I donate, they comment on how high my iron levels are and ask if I’m taking iron supplements (I’m not) or eating a lot of iron-rich foods (no). I am otherwise healthy, except for aches and pains, and being tired all the time.

Should I be concerned about the iron levels? I know that with hemochromatosis, the iron is deposited in vital organs and causes damage. Could this be happening to me?

DEAR READER >> Hemochromatosis is a common but often unrecognized genetic condition caused by an inability to regulate iron absorption. Iron is absorbed as much as possible, all the time, even if the body doesn’t need it. You are right that the iron can affect many tissues of the body, particularly damaging the heart and liver, but also predisposing to certain infections and to diabetes. Your aches and pains also are concerning for joint symptoms, common in hereditary hemochromatosis.

Women who are menstruating have a degree of protection from iron overload, since women lose a quantity of blood each month in menses. Often, women do not become symptomatic until years after menopause. However, this protection is not perfect and there are clearly cases of severe disease in young women.

I don’t have enough information to comment on how likely it is that you might have hemochromatosis. Blood tests can lead a doctor to suspect the diagnosis, and in some cases, can make the diagnosis with high certainty, such as in a person with iron overload by blood testing (a high ferritin level, and a high percentage of bound iron in the blood) combined with a positive genetic test. The diagnosis also can be made by liver biopsy.

I am concerned that the frequent blood donations may have made it harder to make the diagnosis in you, and I’d recommend a consultation with a hemochromatosis expert. I have known both gastroenterologists and hematologists with particular expertise in diagnosing this condition. Treatment is removing the blood, often through donation. My first patient with this condition required 70 units of blood to be removed before his iron levels came back into the normal range.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.