Patients with the finding of cirrhosis on liver biopsy have a decreased survival and a 200-fold increase in the development of hepatocellular carcinoma. Yearly monitoring of the serum alpha-feto protein level is often suggested for patients with hemochromatosis and cirrhosis. A thorough history and physical exam, CBC and chemistries can usually exclude these possibilities. If necessary, liver biopsy can reliably exclude alcoholic liver disease. Patients with alcoholic liver disease typically have indices of less than 2 while patients with hemochromatosis have indices of greater than 2.
Treatment is phlebotomy.
One unit of blood contains 500 ml. of blood and 250 mg. of iron. Mobilizable iron stores in the normal adult are usually between 1 and 2 grams. Patients with hemochromatosis have often accumulated 15 grams or more of iron stores. Phlebotomy creates a relative anemic state in the human and the erythroid series in the marrow responds by increasing red cell production. Iron is utilized in the effort to restore red cell quantity and is gradually removed from tissues such as the heart, pancreas and skin.