African Hemochromatosis or African Iron Overload

category: Diseases and Conditions,MyDocHub
by Leslie RN, BSN, MSN, ARNP,

African iron overload (AIO) (previously known as African siderosis or Bantu siderosis) is a condition observed in sub-Saharan Africans. It is characterized by the accumulation of large amounts of iron in the reticuloendothelial cells of the liver, spleen and bone marrow as well as in hepatocytes. While the distribution of iron differs from that seen in classical type 1 hemochromatosis, organ dysfunction and high levels of body iron of similar magnitude may be found in AIO.

Bantu siderosis, or African iron overload is, as the name implies, a type of hemosiderosis found mostly in Africa. Bantu siderosis affects up to ten percent of the population in some rural African communities.

African iron overload appears to be a genetic hemosiderosis, but the genetic mutation causing African iron overload has yet to be determined. Doctors know that individuals with African iron overload lack the HFE gene mutations associated with the most common genetic iron overload disorder, hemochromatosis.

Originally, this was blamed on ungalvanized barrels used to store home-made beer, which led to increased oxidation and increased iron levels in the beer. Further investigation has shown that only some people drinking this sort of beer get an iron overload syndrome, and that a similar syndrome occurred in people of African descent who have had no contact with this kind of beer.

Risk Factors:
Anyone of African descent. Iron overload is a common condition in Africa where the prevalence of excessive body iron sufficient to cause liver damage affects as many as 10% of the population in some areas.

Spectrum of disease:
Cirrhosis and its complications including hepatocellular carcinoma. Osteoporosis secondary to ascorbic acid deficiency is common in malnourished individuals. Association with heart disease, elevated sugar or diabetes and increased pigmentation has been described.

Detection:
An attending physician can measure serum ferritin and fasting serum iron and TIBC (total iron binding capacity) to determine the transferrin iron saturation percentage (TS%). Characteristically, the serum ferritin rises before the development a high TS% and a serum ferritin greater than 300ng/mL in adult males 200ng/mL adult females with normal TS% (<45%) may indicate AIO. Liver biopsy will show the characteristic distribution of iron.

Treatment:
Therapeutic phlebotomy

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