Clinical management of hemochromatosis: current perspectives

Pierre Brissot,1 Thibault Cavey,1,2 Martine Ropert,1,2 Pascal Guggenbuhl,1,3 Olivier Loréal1 1Inserm UMR991, 2Laboratory of Biochemistry, 3Department of Rheumatology, University Hospital, Rennes, France Abstract: Hemochromatosis (HC) corresponds to systemic iron overload of genetic origin. Its spectrum covers HFE-related HC, a frequent disease exclusively present in Caucasians; however, several entities of non-HFE-related HC, which correspond to very rare disorders, have been observed in both Caucasian and non-Caucasian populations. In most HC forms, iron overload is explained by hepcidin deficiency, which increases iron delivery into the plasma from both duodenal and splenic sources, with subsequent organ iron deposition. The diagnosis depends on a noninvasive approach combining clinical, biological, and imaging data. The treatment remains largely based on phlebotomy therapy, which is rarely replaced with erythrocytapheresis or chelation therapy. Hepcidin supplementation represents the logical therapeutics of the future for all HC forms related to hepcidin deficiency. Keywords: iron overload, HFE, ferroportin, hemojuvelin, transferrin receptor 2, hepcidin, phlebotom