Decreasing iron-related indexes without anaemia in a patient with genetic haemochromatosis

Intern Emerg Med. 2015 Oct;10(7):839-42. doi: 10.1007/s11739-015-1284-7. Epub 2015 Jul 26.

Abstract

Present case report refers to a 48-year-old man with genetic haemochromatosis (C282Y mut/mut) diagnosed at the age of 26. After aggressive iron depleting regimen carried out up to normalization of iron-related indexes, he received a maintenance regimen based on regular phlebotomies for about 20 years. In 2014, a marked reduction of both serum ferritin and transferrin saturation percent, without concomitant anaemia, was noted on two different occasions at 5-month interval. An obscure occult GI bleeding was suspected, but both upper and lower GI tract endoscopy were negative for abnormal findings, as also was a detailed abdominal US scan. The persistence of low iron-related indexes prompted the physicians to perform a videocapsule endoscopy, which showed an ulcerative bleeding lesion in the small bowel, not confirmed however by both anterograde and retrograde double-balloon enteroscopy. Further MRI and PET allowed the identification of a 3.5 cm large lesion, located outside the small bowel wall, suspected to be a gastrointestinal stromal tumour (GIST). A further laparoscopic procedure allowed the resection of 10 cm of midileum, which included the mass, fully consistent with GIST at pathology.

Publication types

  • Case Reports

MeSH terms

  • Anemia / complications
  • Anemia / diagnosis
  • Anemia / etiology*
  • Hemochromatosis / genetics*
  • Hemochromatosis / physiopathology
  • Humans
  • Iron / metabolism*
  • Male
  • Middle Aged

Substances

  • Iron