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      Hemocromatosis hereditaria tipo I: a propósito de cuatro casos confirmados Translated title: Hereditary hemochromatosis type I: apropos of four confirmed cases

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          Abstract

          La hemocromatosis hereditaria es un trastorno genético. En los últimos años se ha profundizado en el conocimiento de su fisiopatología y diagnóstico. Estos síndromes se caracterizan por sobrecarga de hierro y se distinguen varios subtipos de acuerdo con la mutación existente. Dentro de ellas, las mutaciones en el gen HFE o hemocromatosis hereditaria tipo I es la más común. Esta enfermedad tiene una gran morbilidad y mortalidad asociada a la sobrecarga del mineral. Se presentan 4 pacientes en los que por primera vez en Cuba se identificaron las mutaciones del gen HFE.

          Translated abstract

          Hereditary hemochromatosis is a genetic disorder. Detailed studies on its physiopathology and diagnosis have been carried out over the last years. The syndromes are characterized by iron overload and several subtypes are distinguished according to the existing mutation. Among them, the mutations in HFE gene or hereditary hemochromatosis type I is the most common. This disease has a great morbidity and mortality associated to mineral overload. For the first time in Cuba, we report four patients with confirmed mutations in HFE genes.

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          Most cited references33

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          Disorders of iron metabolism. Part II: iron deficiency and iron overload.

          MAIN DISORDERS OF IRON METABOLISM: Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency (ID) and iron deficiency anaemia. In chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, resulting in hypoferraemia and iron restricted erythropoiesis, despite normal iron stores (functional iron deficiency), and finally anaemia of chronic disease (ACD), which can evolve to ACD plus true ID (ACD+ID). In contrast, low hepcidin expression may lead to hereditary haemochromatosis (HH type I, mutations of the HFE gene) and type II (mutations of the hemojuvelin and hepcidin genes). Mutations of transferrin receptor 2 lead to HH type III, whereas those of the ferroportin gene lead to HH type IV. All these syndromes are characterised by iron overload. As transferrin becomes saturated in iron overload states, non-transferrin bound iron appears. Part of this iron is highly reactive (labile plasma iron), inducing free radical formation. Free radicals are responsible for the parenchymal cell injury associated with iron overload syndromes. ROLE OF LABORATORY TESTING IN DIAGNOSIS: In iron deficiency status, laboratory tests may provide evidence of iron depletion in the body or reflect iron deficient red cell production. Increased transferrin saturation and/or ferritin levels are the main cues for further investigation of iron overload. The appropriate combination of different laboratory tests with an integrated algorithm will help to establish a correct diagnosis of iron overload, iron deficiency and anaemia. REVIEW OF TREATMENT OPTIONS: Indications, advantages and side effects of the different options for treating iron overload (phlebotomy and iron chelators) and iron deficiency (oral or intravenous iron formulations) will be discussed.
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            How I treat hemochromatosis.

            Hemochromatosis is a common genetic disorder in which iron may progressively accumulate in the liver, heart, and other organs. The primary goal of therapy is iron depletion to normalize body iron stores and to prevent or decrease organ dysfunction. The primary therapy to normalize iron stores is phlebotomy. In this opinion article, we discuss the indications for and monitoring of phlebotomy therapy to achieve iron depletion, maintenance therapy, dietary and pharmacologic maneuvers that could reduce iron absorption, and the role of voluntary blood donation.
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              Review article: the iron overload syndromes.

              Iron overload syndromes encompass a wide range of hereditary and acquired conditions. Major developments in the field of genetics and the discovery of hepcidin as a central regulator of iron homeostasis have greatly increased our understanding of the pathophysiology of iron overload syndromes.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                hih
                Revista Cubana de Hematología, Inmunología y Hemoterapia
                Rev Cubana Hematol Inmunol Hemoter
                Editorial Ciencias Médicas (Ciudad de la Habana )
                1561-2996
                March 2014
                : 30
                : 1
                : 59-67
                Affiliations
                [1 ] Instituto de Hematología e Inmunología Cuba
                [2 ] Hospital General Docente Enrique Cabrera Cuba
                [3 ] Centro Nacional de Genética Médica Argentina
                Article
                S0864-02892014000100008
                5765c27a-b23e-42da-b153-1ea3b60a9f1e

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=0864-0289&lng=en
                Categories
                HEMATOLOGY

                Hematology
                hereditary hemochromatosis,HFE,C282Y mutation,iron overload,hemocromatosis hereditaria,mutación C282Y,sobrecarga de hierro

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