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Hépato-Gastro & Oncologie Digestive

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Iron overload Volume 18, issue 4, Juillet-Août 2011

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Authors
CHU Pontchaillou, centre de référence des surcharges en fer rares d’origine génétique, service des maladies du foie, Inserm UMR U-991, 2, rue Henri-Le-Guilloux, 35033 Rennes Cedex 9, France

Iron overload management is one of the hepato-gastroenterologist tasks. Indeed, the liver plays a major role in the regulation of iron metabolism but is also a primary target of iron overload. As for the digestive tract, it is the only entry route of iron into the body. Hepcidin deficiency explains iron excess (with increased serum iron, increased transferrin saturation and parenchymal overload) in many genetic situations (hemochromatosis types 1, 2 and 3) but also contributes to excess iron in acquired situations (alcohol). Ferroportin activity deficiency (hemochromatosis type 4) is a genetic iron overload with normal or low serum iron (and transferrin saturation) and preferential iron deposition within macrophages. Through clinical examination, biochemical assays, imaging techniques (MRI) and genetic testing, the diagnosis of iron overload may be most often obtained non-invasively. Oral iron chelation has transformed the treatment of hematological iron overload and could find a place, although limited, in the treatment of genetic iron excess. Manipulation of hepcidin levels represents an innovative therapeutic approach designed to replace, in the future, bleeding therapy.