Venesection therapy of insulin resistance-associated hepatic iron overload

Background/Aims: The association of hepatic iron overload with metabolic di sorders has been coined as the insulin resistance-associated hepatic iron o verload syndrome (IR-HIO). Methods: Fifty-six IR-HIO patients were phlebotomized either weekly (n = 14 ) or bimonthly (n = 42) and compared with C282Y homozygotes and with ten IR -HIO patients treated by a low calorie diet alone. Results: In venesected patients, the median amount of mobilized iron was 0. 6 g in 2.8 months in females and 1.8 g in 5 months in males. Mobilized iron did not differ depending on the frequency of venesections or HFE genotype. When compared with C282Y homozygotes, IR-HIO patients had a similar amount of mobilized iron, but three-fold serum ferritin levels. The presenting sy mptoms (chronic fatigue and/or polyarthralgias) improved in 6/7 patients. P hlebotomies were well tolerated. In patients treated by a low calorie diet, serum ferritin levels remained stable. Conclusions: In IR-HIO patients, body iron stores are significantly increas ed, overestimated by serum ferritin, not modified by a low calorie diet, an d safely removed by phlebotomies. Based on these data and on studies indica ting that iron excess is associated with increased risk for hepatic fibrosi s, cancer and cardiovascular disorders, venesection therapy can be recommen ded in IR-HIO patients. (C) 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.