Disturbances of iron metabolism in chronic liver diseases

Systematic biochemical and histopathological studies carried out in patients with diagnosed chronic liver diseases (cirrhosis, hepatocellular carcinoma) confirm the important pathogenetic role of commonly occurring accumulation of iron deposits, and not only in the classic form of hemochromatosis. The reports concern the pathologic role of iron storage in the liver often accompanying metabolic disturbance syndrome including obesity, type II diabetes and hypertension. The aim of the study was preliminary assessment of the incidence of iron metabolism disturbances in the population of patients with chronic liver diseases.

Among 351 patients of the Department of Infectious Diseases who had histopathologic investigations of liver bioptates performed in 2000-2001, 99 subjects (28%) with morphological confirmation of iron deposition in the liver were selected. Retrospective analysis based on data from the patients' medical records took into consideration demographic information, results of laboratory tests (blood levels of hemoglobin, ALAT, iron, ferritin) and the ultimate diagnosis. The correlations between iron metabolism disturbances and the observed liver pathology were analyzed.

The study group consisted of 99 subjects including 77 males (mean age 42.8 yrs) and 22 females (mean age 47.5 yrs). Most of them had been diagnosed with chronic hepatitis C, (N = 39). Liver damage due to hyperlipidemia was diagnosed in 12, and toxic liver damage in 11 patients. Subjects with chronic renal failure and after antitumor therapy accounted for 14%. In 7 patients, hemochromatosis was diagnosed or suspected. In that group, mean serum ferritin level amounted to 959.3 ng/ml. In 79% of cases, ALT values fell within the 41-500 IU/l range, whereas iron and ferritin levels exceeded the normal limits in 49% and 71% of cases, respectively. The preliminary analysis of pathologic iron accumulation in liver bioptates in relation to biochemical parameters of iron metabolism measured in the blood did not allow unequivocal confirmation of linear correlation between these phenomena.

1. Over 1/4 of patients diagnosed because of chronic liver diseases demonstrated excessive accumulation of iron in liver bioptates. 2. The analyzed group consisted predominantly of males with chronic hepatitis C. 3. Metabolic or toxic liver damage was diagnosed n 1/3 of cases. 4. No unequivocal confirmation of correlation between pathologic iron accumulation in the liver and values of iron metabolism parameters in blood was obtained.