December 15, 2022
Welcome Back to Part II in our Series where Dr. Joe DeStefano of Urgent Care 24/7 discusses Iron Deficiencies.
There are people who are iron deficient, have a defect in their GI tract. You do a big workup on them. They don't have ulcers, they don't have Crohn's disease. They don't have a cancer. They swear compliance with their iron. They tell you that their stools are black from taking your iron, and they are still iron deficient. These people actually have a problem with their iron transport genes and don't absorb iron. Well, they will need IV iron infusion. Now the other problem with iron is iron overload syndrome. Hemochromatosis, we call it the most common cause of hemochromatosis, is a hereditary hemochromatosis. The most common gene causing this is Y2A2, the next most common gene is HD63.
The next one goes by the name 4S, which are other names. There are often other minor genes, but the two main reasons to worry about are why HD 63 hereditary hemochromatosis is the most common genetic disease of Caucasians. It is common in Europeans of Scottish and Irish to set. The highest levels of symptomatic hemochromatosis are found in western North Carolina, upstate South Carolina and middle North Carolina, wherever there was a high population of Scots Irish. Nova Scotia, New Scotland, of course, has a lot of hemochromatosis New Zealand settled by many Scots Irish a lot of hemochromatosis.
Hemochromatosis in males and division develops historically about 10 to 20 years earlier than hemochromatosis in females. This is changing, however, because the new birth control pills, which allow women to only have periods four times a year two times a year, mean that if the woman has like 2A2 genes, they're what we call a Y2A2 homozygote, they will start to acquire large amounts of iron, just like the male would.
The early signs of hemochromatosis. The asymptomatic phase, as we call it, may be some depression, some fatigue, some insulin resistance, blood sugar start to get a little high. Some aches and pains. Just almost like a chronic fatigue syndrome is what I would call the early phases of iron overload syndrome hemochromatosis. As the disease becomes more advanced, the iron starts to deposit in the testes, it starts to deposit in the pituitary, it starts to deposit into the amygdala of the brain and starts to deposit all the tickler services in the joints.
So as the iron overload syndrome worsens, the patient will develop arthritic symptoms, they will develop what we call a bronze diabetes, because they become diabetic from increased insulin resistance from the iron plus iron poisoning the islet cells in the pancreas plus, so have a pretty bronze tan with no tan lines because their skin is filled with iron.
The more severe cases, the iron shows up in the MRI scans of the brain. This is called advanced hemochromatosis, which causes cirrhosis of the liver as the liver filled with iron, trying to control the iron levels in the blood. Also, these elevated iron levels escaped the body's ability to sequester iron from microorganisms. So people with high iron levels in hereditary hemochromatosis will get life-threatening bacterial infections that normal people will not get, such as Vibrio, they'll never get infections walking on the beach. So iron level monitoring is important, especially in high risk populations in the southeast United States. It should be considered part of any depression workup.
Check for on an overload, since often depression is one of the first presenting symptoms. Be aware of your family history. It is already human. Hereditary hemochromatosis is hereditary. These genes are passed down in families. Often the families don't have clusters of depression, suicide, and cirrhosis. Be self aware of your family history and ethnic background.
We are aware of it in Urgent Care 247, and it's part of our holistic approach to health care. We try to ensure that we know the iron saturation levels of our patients.
Thanks for this time to chat about iron disorders.
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