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Iron Overload: Treatment, Procedure, Cost and Side Effects

What is the treatment?

Hemochromatosis is a disease whereby excess iron builds up in a person’s body. A person suffering from this condition absorbs more iron than is actually required. The body is not capable of getting rid of the extra iron and it gets stored in the body tissues and especially in the liver, heart and pancreas. This extra iron can be detrimental for your body and can cause organ failure. People with this disorder can absorb up to 30 % of the iron that they consume compared to the 10 % which is absorbed by normal people. The body is then not able to expel the extra iron and it gets stored.

Iron overload disorder can either be primary hemochromatosis or secondary hemochromatosis. Primary hemochromatosis accounts for the overwhelming majority of the cases and is passed on genetically. On the other hand, secondary hemochromatosis can be a result of some kind of anemia like thalassemia or can be the result of liver diseases like Hepatitis C and alcoholic liver disease.

The three major methods for treating hemochromatosis are therapeutic phlebotomy, iron chelation therapy and dietary changes in the person suffering from the disorder. It is essential to diagnose this disorder in the early stages or otherwise there can be serious repercussions.

How is the treatment done?

Blood is removed from the body via therapeutic phlebotomy. At first, a needle is inserted into a vein and then the blood flows through an airtight tube into a sterile container or bag. As the process is similar to blood donation, it can be done at blood donation centers or even at a doctor’s chamber. Patients should have weekly phlebotomy of about 500 ml of blood which is equivalent to 200-250 mg of iron. This therapy should done till iron-limited erythropoiesis develops and this can be identified by the failure of hemoglobin level and/or hematocrit. Patients can generally withstand bi-weekly phlebotomy but this process is tedious.

For people who cannot have routine blood removal, iron chelation therapy is used. This procedure uses medicines to remove excess iron from the body. The medicine used in this procedure can be injected or can also be consumed orally. This procedure is ordinarily recommended for people with hemachromatosis and heart disease, anemia or poor venous access.

Furthermore, there are some dietary changes that a patient needs to incorporate. He/she should avoid iron, including iron pills, iron injections and multivitamins containing iron. The person should also limit his/her intake of Vitamin C as it aids in the absorption of iron from food. Fish and shellfish should be avoided they contain bacteria that may cause infections in people suffering from iron overload disorder. Alcohol should also be avoided as it causes liver damage.

Who is eligible for the treatment? (When is the treatment done?)

A person suffering from iron overload disorder is eligible for this treatment. There are two types of tests that can detect whether a person has hemochromatosis or not. However, a person becomes eligible for treatment if he/she is suffering from one or more of the following symptoms: diabetes, elevated liver enzymes, extreme tiredness, joint problems, heart disease or erectile dysfunction (in men). The two tests that can help to detect iron overload are serum transferrin saturation and serum ferritin. Moreover, people who can withstand frequent blood transfer are eligible for iron chelation therapy.

Who is not eligible for the treatment?

Patients suffering from anemia cannot undergo phlebotomy and have to be treated with iron chelation agents. People who cannot withstand regular blood removal procedures are not eligible for phlebotomy. A doctor’s diagnosis is necessary to understand whether a person is suffering from iron overload disorder. Without a proper diagnosis, a person is not eligible for treatment.

Are there any side effects?

Iron chelation therapy requires the injection or consumption of drugs by a patient. However, there are certain side-effects associated with IV iron chelation therapy like visual disturbances, rashes or hives, diarrhea, vomiting, itchiness, cramps in the stomach and legs and rapid heart-beat. It may also cause fever, low blood pressure, anaphylactic shock, dizziness and pain and swelling at the site of the intravenous injection.

Some of the side-effects of therapeutic phlebotomy are fatigue, anemia, tiredness, dizziness and a feeling of exhaustion.

What are the post-treatment guidelines?

Therapeutic phlebotomy is done till a patient’s ferritin level reaches a certain prescribed level. However, even after ferritin levels are normal, a person will have to take extra care so as to ensure that iron levels in his/her blood do not get elevated again. The ferritin levels can be maintained by donating blood at regular intervals.

Patients generally develop a few symptoms after iron chelation therapy. It is of utmost importance that the patient reports such symptoms to a doctor so that he/she adjusts the dosage of the medicine. A patient’s visual status and hearing status are checked by slit-lamp fundoscopy and a hearing test respectively. A kidney functioning test may also be done.

How long does it take to recover?

Therapeutic phlebotomy is generally carried out once every 2-3 months. This therapy may remove some of the symptoms like fatigue, abdominal pain, elevated liver enzymes and other symptoms associated with iron overload disorder. But it is not able to treat other complications. Iron chelation therapy uses drugs to bring down the level of iron in a person’s blood. However, both these treatments are to be continued for life in a person suffering from hemochromatosis.

What is the price of the treatment in India?

A person suffering from sickle-cell disease can develop complications like liver dysfunction or cirrhosis, diabetes, arthropathy and cardiac enlargement. The iron chelator treatment which is done to treat iron overload is a bit costly. The price of drugs used for this treatment is more than Rs 900000 for a month.

Phlebotomy can cost between Rs 2000 to Rs 13000.

Are the results of the treatment permanent?

Therapeutic phlebotomy and iron chelation therapy are both used to bring down the level of iron in the blood of a person suffering from iron overload syndrome. However, this disorder can be genetic or as an effect of some other health disorder. Although both the procedures bring down the level of iron in blood, they do not provide a permanent solution. A person has to keep on taking medications or donating blood.

What are the alternatives to the treatment?

A person can include turmeric in his/her diet to fight iron overload disorder. The turmeric acts to reduce stored iron from the cells. It has been clinically proven that level of iron in the blood decreases with the increase in the level of turmeric. Topical turmeric creams and phytosomal turmeric capsules are beneficial in this respect.

Safety: High Effectiveness: High Timeliness: Medium Relative Risk: Low Side Effects: Low Time For Recovery: Medium Price Range: Rs 2000 - Rs 13000 for phlebotomy;

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