Clinical practice guidelines on hemochromatosis: Asian Pacific Association for the Study of the Liver
School of Medical and Health Sciences
Hereditary hemochromatosis is the result of pathogenic variants in multiple genes that can result in increased body iron stores with excess iron deposited in various organs, including the liver, pancreas, and heart. The two most important advances in the field over the past 30 years have been the identification of the HFE gene (and the associated p.Cys282Tyr substitution), and the discovery of the hormone hepcidin, which is inappropriately low in this condition and is the pathophysiological basis of the increased iron absorption. The identification of mutations in the HFE gene and subsequent studies have reshaped diagnostic algorithms resulting in a marked reduction in the need for liver biopsy. The discovery of hepcidin has resulted in many studies that have dramatically improved our understanding of iron metabolism with clear potential therapeutic implications. The variable clinical expression of hemochromatosis has puzzled clinicians and scientists, and our understanding of the factors that influence the phenotype has increased over recent years. Nevertheless, increased clinician and patient awareness, early diagnosis, and therapeutic phlebotomy to restore normal life expectancy are still the cornerstones of management. The classic triad of cirrhosis, diabetes, and skin pigmentation is now uncommon, and many patients are diagnosed with minimal or no symptoms.
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Crawford, D. H., Ramm, G. A., Bridle, K. R., Nicoll, A. J., Delatycki, M. B., & Olynyk, J. K. (2023). Clinical practice guidelines on hemochromatosis: Asian Pacific Association for the Study of the Liver. Hepatology International. Advance online publication. https://doi.org/10.1007/s12072-023-10510-3