Iron overload secondary to cirrhosis: a mimic of hereditary haemochromatosis?

Aims Hepatic iron deposition unrelated to hereditary haemochromatosis is common in cirrhosis. The aim of this study was to determine whether hepatic haemosiderosis secondary to cirrhosis is associated with iron deposition in extrahepatic organs. Methods and results Records of consecutive adult patie...

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Bibliographic Details
Published in:Histopathology 2014-10, Vol.65 (4), p.561-569
Main Authors: Abu Rajab, Murad, Guerin, Leana, Lee, Pauline, Brown, Kyle E
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
cardiomyopathy
Coloring Agents
Female
Ferrocyanides
Genotype
haemosiderosis
Hemochromatosis - pathology
Hemochromatosis Protein
hepcidin
HFE
Histocompatibility Antigens Class I - genetics
Humans
Iron Overload - etiology
Iron Overload - pathology
Liver Cirrhosis - complications
Male
Membrane Proteins - genetics
Middle Aged
Mutation
pancreas
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Summary:Aims Hepatic iron deposition unrelated to hereditary haemochromatosis is common in cirrhosis. The aim of this study was to determine whether hepatic haemosiderosis secondary to cirrhosis is associated with iron deposition in extrahepatic organs. Methods and results Records of consecutive adult patients with cirrhosis who underwent autopsy were reviewed. Storage iron was assessed by histochemical staining of sections of liver, heart, pancreas and spleen. HFE genotyping was performed on subjects with significant liver, cardiac and/or pancreatic iron. The 104 individuals were predominantly male (63%), with a mean age of 55 years. About half (46%) had stainable hepatocyte iron, 2+ or less in most cases. In six subjects, there was heavy iron deposition (4+) in hepatocytes and biliary epithelium. All six of these cases had pancreatic iron and five also had cardiac iron. None of these subjects had an explanatory HFE genotype. Conclusions In this series, heavy hepatocyte iron deposition secondary to cirrhosis was commonly associated with pancreatic and cardiac iron. Although this phenomenon appears to be relatively uncommon, the resulting pattern of iron deposition is similar to haemochromatosis. Patients with marked hepatic haemosiderosis secondary to cirrhosis may be at risk of developing extrahepatic complications of iron overload.
ISSN:0309-0167
1365-2559
DOI:10.1111/his.12417