GIPA

[honey1616]

Trying to figure this all out and it just dawned on me that there was some postings about this a few days ago.  TinaB..her hubby had relapsed and the dr said it was due to high iron. I'm just wanting to know..blood test for my husband right before starting treatment the iron was ok at 138 but below it is ferritin and it is high at 638.  We both had no idea what this was.  My hubby is coming up 7/48 so I definitely would hate for him to be wasting his time on tx if this was working against him.  Is there a problem with this and also do you know if you could reduce this ferritin number on your own?  Thank you

[mikesimon]

Gastroenterology. 1995 Apr;108(4):1104-9.  Related Articles, Links  

  
Hepatic iron concentration as a predictor of response to interferon alfa therapy in chronic hepatitis C.

Olynyk JK, Reddy KR, Di Bisceglie AM, Jeffers LJ, Parker TI, Radick JL, Schiff ER, Bacon BR.

Division of Gastroenterology and Hepatology, St. Louis University Health Sciences Center, Missouri.

BACKGROUND/AIMS: It has been reported that hepatic iron concentration (HIC) may influence response to therapy in chronic viral hepatitis. The aim of this study was to determine the relationship between HIC and response to interferon alfa therapy in patients with chronic hepatitis C. METHODS: HIC was measured in liver biopsy specimens from 58 patients with chronic hepatitis C treated at three centers. Three patients had mild chronic hepatitis C, 35 had moderate to severe chronic hepatitis C, and 20 had active cirrhosis. Serum ferritin levels were measured in 51 of these 58 patients. Response to therapy was defined as normalization of alanine aminotransferase levels at the end of treatment. RESULTS: Twenty-four patients (41%) responded to therapy. HICs were generally within the normal range (< 1500 micrograms/g). The mean HIC in nonresponders (860 +/- 100 micrograms/g; range, 116-2296 micrograms/g) was significantly higher than in responders (548 +/- 85 micrograms/g; range, 29-1870 micrograms/g) (P < 0.05). Eighty-eight percent of patients with an HIC of > 1100 micrograms/g and 87% of patients with an elevated serum ferritin concentration did not respond to interferon alfa therapy. CONCLUSIONS: HIC seems to influence response to interferon alfa therapy among patients with chronic hepatitis C. A subgroup of patients with chronic hepatitis C has been identified for which an HIC of > 1100 micrograms/g predicted nonresponse in 88% of patients.

PMID: 7698578 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------
Mike

[mikesimon]

Gastroenterol. 1997 Aug;92(8):1298-1301.  Related Articles, Links  


Iron overload in patients with chronic viral hepatitis: how common is it?

Riggio O, Montagnese F, Fiore P, Folino S, Giambartolomei S, Gandin C, Merli M, Quinti I, Violante N, Caroli S, Senofonte O, Capocaccia L.

2a Gastroenterologia and Immunologia ed Allergologia Clinica, Universita La Sapienza di Roma, Rome, Italy.

OBJECTIVES: To establish the prevalence of increased hepatic iron content in patients with hepatitis C virus-related chronic hepatitis and to assess the accuracy of serum iron and ferritin in detecting tissue iron overload. METHODS: Serum iron, serum ferritin, and hepatic iron content were determined in 81 consecutive patients undergoing liver biopsy for chronic ALT elevation and hepatitis C virus infection. Moreover, in a subgroup of 28 patients, outcome of a 6-month course of interferon (IFN) treatment (6 million U of recombinant IFN, three times weekly) was determined after a mean follow-up of 24 +/- 6 months and the outcome was compared with the pretreatment values of hepatic iron content. RESULTS: Elevated serum iron or ferritin levels were detected in approximately 40% of patients, but elevated hepatic iron content was observed in only eight patients (10%). One of these patients had a hepatic iron index > 1.9, indicating hemochromatosis. Liver iron content and serum iron levels were not correlated. No differences in hepatic iron content were observed among patients with a sustained response to IFN (seven patients), short-term responders (seven patients), or nonresponders (14 patients). CONCLUSIONS: Ten percent of patients with chronic hepatitis C have elevated hepatic iron content. These patients cannot be identified using serum markers of iron status. The relationship between liver iron and response to IFN treatment requires further prospective investigations.

PMID: 9260793 [PubMed - indexed for MEDLINE]

[mikesimon]

Ferritin levels can be reduced through phlebotomy (blood letting). This is an approach when hemochromatosis is the problem. Each 500 mL of blood extracted removes approximately 200 mg of iron. I am not suggesting this is appropriate for your husband - only that it is one way of reducing serum ferritin levels. I know of no other method though that doesn't mean there aren't any. Mike

[Fubarcat]

Hey Mike - I note the articles you posted were published in 1992 and 1995.  I wonder if there is anything more current on this?  Surely there must be because the two articles appear to conflict with each other if my fog addled brain is reading it correctly.  Thanks for your help.

[Fubarcat]

Sorry - they were dated 1995 and 1997.  I would still think there must be more current literature on this issue, don't you?

[mikesimon]

Articles  

Back  
    
Iron depletion and response to interferon in chronic hepatitis C  
  
  Hepatogastroenterology. 2003 Sep-Oct;50(53):1467-71.

Carlo C, Daniela P, Giancarlo C.

Department of Internal Medicine, Ospedale Civile, Via Taverna 49, 29100 Piacenza, Italy. ***@****

BACKGROUND/AIMS: Chronic viral hepatitis is associated with elevated serum iron indexes, and iron accumulation in the liver may contribute to liver injury and fibrosis due to hepatitis as well as increased risk of developing hepatocellular carcinoma. We studied the effect of iron depletion on the response to subsequent interferon therapy in chronic hepatitis C.

METHODOLOGY: A population of 83 patients affected by chronic hepatitis C who had not previously undergone any specific therapy and who had laboratory confirmation of iron overload (serum ferritin > 400 ng/mL in the males and > 300 ng/mL in the females) was divided into two homogeneous groups. The 43 patients in Group A underwent phlebotomy (300 mL every 10-15 days for an average total of 8 sessions) until their serum ferritin levels were < 100 ng/mL. The 40 patients in Group B were treated with interferon without prior iron depletion.

RESULTS: In Group A, iron depletion alone induced a highly significant (p < 0.01) reduction of alanine aminotransferase serum values: from 165 U/L (range: 60-370 U/L). Seventy-six patients completed therapy and follow-up: a complete and sustained response was obtained in 12/39 cases in Group A and in 6/37 cases in group B (p< 0.05).

CONCLUSIONS: Iron depletion carried out in patients with chronic hepatitis C who have elevated serum ferritin values induces a significant reduction in necro-inflammatory activity (notable decrease in average alanine aminotransferase values) and improves their response to subsequent treatment with interferon, although it does not modify the viral load.  

[tina b]

Hemochromotosis is most common in white males of European descent. It usually doesn't effect females because we loose blood every month anyway so our bodies don't get a chance to store to much until after menapause. ( I wish I had learned to spell in school) You can be anemic and still have hemochromotosis (to much stored iron). Your husbands ferritin is way to high. It could be caused my hemochromotosis or the hepc itself. The docs really don't treat it during tx because the blood is so messed up to begin with. Removing the iron can cause anemia. When my husband did the draws, the rule was....get the ferritin below 50 without getting the Hgb below 10....The reference range for ferritin is 22-322, your husbands is twice what it should be. He must feel lousy! Your iron and your ferritin are NOT the same thing. Some iron is needed in everyones blood of we become anemic, ferritin is STORED iron. The "iron" in his blood is in normal range 50-160. My husbands iron was 182 (little high)on 5-9-03 but his ferritin was 2092.5 on the same day. These meds can increase ferritin. There are only 2 ways to get rid of iron, one is to have a pint of blood drawn off weekly, some dr's do bi-weekly until the iron storage is brought down, and there is a pill but most docs don't like to use it because it is very hard to tell just how much iron is being removed and it has to be processed by the liver and most hepc patients don't need anything else processed through the liver. I wish somebody could explain to me why these doctors order blood tests and spend our money and then ignore the blood test results?! To much iron will make a person as mean as riba rage sometimes, even if they are not on riba. To much iron is toxic to the system. My dad says that iron overload (when a kid eats extra vit.)is the #1 cause of death in children.
If your husband is like mine, he will just ignore it and suggest that you can't believe everything you read or see on the internet, but it is very important to get this checked......it really could mean the difference between beating the dragon or not. Go to google and look it up......the answer is always the same, reduce iron storage before starting tx. Good Luck!

[honey1616]

Thanks guys for the research/advice.  Yeah..its really weird that we do get all these bloodtests and honestly we never have been sick so we don't know what half of it means and I remember reading your post Tina and today it just hit me.  I remembered seeing something on my husbands original bloodwork that neither of us knew what it was.  I have done the research this afternoon and you are right..it doesn't look great to be on tx before addressing the ferritin.  Uggghhhh..and you are so right..I'm telling my husband and he is saying its probably lower now! That blood work was done in October and I don't see it on anymore of his bloodwork.  Looks like lately..maybe they aren't taking as detailed of bloodwork as when trying to find out why his liver enzymes were so high.  So..I guess at this point I'm not sure what to do as I know he is not wanting to stop tx and start again another day.  As far as him feeling bad before...He never did.  He has never been sick at all and until recently starting tx which has slowed him down somewhat.

[tina b]

Hi, My husband didn't feel bad until starting tx the first time either, until he got rid of the iron and then he realized how he had gotten use to feeling like he did, now he calls it bad, but before it was normal. He never complained about feeling bad before he got rid of the iron but now he says almost daily how good he feels, he just did 1/48 about 2 hours ago so this will pass, poor guy. If I were you, I would and did go around my husband to the Dr. (actually the nurse) and insist on some extra tests for that ferritin. You gotta look out for him, he isn't gonna do it for himself if he is like mine. Good luck.