Q. I attended my doctor recently for a check-up as I was feeling very tired. She ordered some bloods and apparently my iron levels have come back quite high. I'm due to go back to her for more tests. I thought low iron made you feel tired and but I'm quite worried now. Is this serious and what can I do? Mark, Wexford
A. Well done for going to your doctor for a check-up. You don't mention your age but men aren't renowned for their attendance for problems such as fatigue. It is always important to get checked out as tiredness can be a symptom of several underlying medical problems, some of which can be serious.
Your GP has been very thorough, as not everyone checks iron levels – although they should. There are two main tests to check iron – your iron saturation levels and the levels of ferritin in your blood.
You are correct in saying low iron can cause tiredness. This is usually due to anaemia and the main cause here is most commonly either blood loss or insufficient iron in the diet. If the tests show elevated levels of iron in the blood, it is most likely that you have a condition called Hereditary Haemochromatosis (HH). This is a genetic condition in which the body absorbs too much iron and it is particularly common among the Irish population.
In most parts of Europe, one-in-400 people will develop the condition, but one in five people of Celtic origin carries the gene, meaning it occurs in approximately one in 80 people here.
Haemochromatosis is sometimes referred to as the Celtic Curse due to its high levels in this population. The body can only store so much iron. When the stores become full up, any extra circulating iron gets deposited in various organs. If the levels continue to increase and the condition goes untreated it can cause irreversible and potentially fatal organ damage.
HH usually shows itself in the fourth or fifth decade of life, but a diet high in food supplements or in alcohol (which increases iron absorption) can cause symptoms earlier in life. Tiredness can be a symptom of HH. Others include muscle and joint pain and abdominal discomfort, diabetes and darkening of the skin.
If iron overload goes unchecked, the skin may become more bronzed and diabetes, cirrhosis and heart problems can follow. However, once diagnosed, HH is a manageable condition. You have been told your iron levels are high, so the next test is a specific blood test that checks for the two common genes that cause HH.
If you are diagnosed as having haemochromatosis, treatment is surprisingly simple. It involves regular bloodletting called venesection, a process akin to giving blood.
If iron levels are very high, treatment is usually weekly. Ferritin levels are then monitored and further treatment is based on these results. With increased awareness of the condition, more people in Ireland are being screened and diagnosed early. As this is a genetic condition, if you have it then your siblings will need to be screened. If you have children, their mother should be tested. If she carries the gene, then your children will also eventually require testing.
Treatment, once commenced, is lifelong, but if iron levels are kept within normal limits organ damage is unlikely and life expectancy is normal. There are other causes of high ferritin levels without high iron saturation, so it is important that both tests have been carried out. A simple infection, inflammation or alcohol can cause the ferritin levels to climb quite high and this is not haemochromatosis. So do go back to your doctor for follow-up, but, rest assured, it is likely that the results and plan will be entirely manageable.