Hemochromatosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Hemochromatosis is divided on basis of it's etiology. Hereditary hemochromatosis is caused by defect in gene and secondary hemochromatosis is caused by excess absorption of iron, repeated blood transfusions, or excess oral intake, typically in patients with disorders of erythropoiesis.

Classification

Hemochromatosis can be classified on basis of mode of entry of iron source:

Entral:

The entral source of hemochromatosis is hereditary hemochromatsis.[1][2]

  • Hereditary hemochromatosis is an autosomal recessive disorder having genetic mutation that affect HFE proteins that limit the entry of iron into the blood by regulating hepcidin, the primary iron regulatory hormone.
Paraentral:
  • Paraentral haemochromatosis refers to patients who get multiple blood transfusions.
  • It is commonly found in patients with hemoglobinopathies such as Thalasmia major.
Placental:

Placental haemochromatosis/Neonatal hemochromatosis to condition in which fetus has deposited iron in it's hepatic and or extra-hepatic tissue pathologically.[3][4][5]

  • Gestational alloimmune liver disease is cause of fetal liver injury that occurs in all cases of Neonatal hemochromatosis.
  • In fetus the level of TFR1, transferrin, and ferritin is found high.
  • It is unclear what is the cause but it is believed that fetal blood extracts more iron from maternal blood.
  • As the fetal liver is damaged, it causes decreased levels of Hepcidin.
Description OMIM Mutation Locus
Haemochromatosis type 1: "classical"-haemochromatosis 235200 HFE 6p21.3
Haemochromatosis type 2A: juvenile haemochromatosis 602390 hemojuvelin ("HJV", also known as HFE2) 1q21
Haemochromatosis type 2B: juvenile haemochromatosis 606464 hepcidin antimicrobial peptide (HAMP) or HFE2B 19q13
Haemochromatosis type 3 604720 transferrin receptor-2 (TFR2 or HFE3) 7q22
Haemochromatosis type 4 autosomal dominant haemochromatosis (all others are recessive), gene mutation 604653 ferroportin (SLC11A3) 2q32

References

  1. Liu J, Sun B, Yin H, Liu S (2016). "Hepcidin: A Promising Therapeutic Target for Iron Disorders: A Systematic Review". Medicine (Baltimore). 95 (14): e3150. doi:10.1097/MD.0000000000003150. PMC 4998755. PMID 27057839.
  2. Crownover BK, Covey CJ (2013). "Hereditary hemochromatosis". Am Fam Physician. 87 (3): 183–90. PMID 23418762.
  3. Feldman AG, Whitington PF (2013). "Neonatal hemochromatosis". J Clin Exp Hepatol. 3 (4): 313–20. doi:10.1016/j.jceh.2013.10.004. PMC 3940210. PMID 25755519.
  4. Parkkila S, Waheed A, Britton RS, Bacon BR, Zhou XY, Tomatsu S; et al. (1997). "Association of the transferrin receptor in human placenta with HFE, the protein defective in hereditary hemochromatosis". Proc Natl Acad Sci U S A. 94 (24): 13198–202. PMC 24286. PMID 9371823.
  5. Shimono A, Imoto Y, Sakamoto H, Chiba Y, Matsumoto K, Kawauchi M; et al. (2016). "An immunohistochemical study of placental syncytiotrophoblasts in neonatal hemochromatosis". Placenta. 48: 49–55. doi:10.1016/j.placenta.2016.10.005. PMID 27871472.

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