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Screening for Hemochromatosis and Iron Deficiency in Employees and Primary Care Patients in Western Germany

Claus Niederau, MD; Christoph M. Niederau, MD; Stefan Lange, MD; Andrea Littauer, MD; Nabil Abdel-Jalil, MD; Michael Maurer, MD; Dieter Haussinger, MD; and Georg Strohmeyer, MD
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From Heinrich-Heine-Universitat Dusseldorf, Ruhr-Universitat Bochum, and Mannesmannrohren Werke AG, Dusseldorf, Germany. Acknowledgments: The authors thank Dr. Schrader (Mannesmann-Rohren Werke AG); Drs. Dietrich, Muller-Ost, and Reifferscheid (Henkel AG); and Dr. Christoph-Karababa (Betriebsarzt, University Dusseldorf) for providing data on employees. They thank Drs. Azimi, Dudeck, Ernst, Littauer, Massion, Reinauer, Roper, Scheinder, and Seidenstocker for providing data on outpatients. Grant Support: In part by the Deutsche Forschungsgemeinschaft (Ni 224/6) and the Van Meeteren-Foundation (Dr. Niederau). The grant proposals contained the prospective protocol. Requests for Reprints: Claus Niederau, MD, Department of Medicine, Division of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-Universitat Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany. Current Author Addresses: Drs. Claus Niederau, Littauer, Abdel-Jalil, Haussinger, and Strohmeyer: Department of Medicine, Division of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-Universitat Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(5):337-345. doi:10.7326/0003-4819-128-5-199803010-00001
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Background: Many physicians still believe that iron overload (hemochromatosis) is an uncommon disorder.

Objective: To estimate the frequency of iron overload and iron deficiency in a group of employees and a group of outpatients.

Design: Prospective screening study.

Setting: Western Germany.

Participants: 3012 asymptomatic employees and 3027 outpatients of nine practitioners.

Measurements: Serum ferritin levels and transferrin saturation were measured. Participants with repeatedly abnormal results had thorough clinical evaluations to identify the cause of iron deficiency or overload.

Results: Gross iron overload (elevated transferrin saturation and ferritin levels) was proven by liver biopsy and phlebotomy treatment in 28 participants (0.4% of female outpatients, 0.7% of male outpatients, 0.2% of female employees, and 0.4% of male employees) and in six siblings of these participants. Of the 34 participants with iron overload, 30 were precirrhotic. Because 60% of an unselected group of employees with elevated transferrin saturation but normal ferritin levels were assumed to have early hemochromatosis, the prevalence of hemochromatosis was estimated to be 1.8% among patients (1.9% in women and 1.6% in men) and 1.0% among employees (1.1% in women and 1.0% in men). Iron deficiency was found in 6.8% of female patients, 2.4% of male patients, 6.0% of female employees, and 0.5% of male employees.

Conclusions: Iron deficiency was more common in women, and iron overload was more common in men. Among male employees, iron overload was almost as common as iron deficiency.


Grahic Jump Location
Figure 1.
Flow chart of examinations for the detection of iron overload.

Percentages given in parentheses are percentages of the values in the previous line, with the exception of the percentages in the third and fourth rows. These values are percentages of the total number of participants.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Flow chart of examinations for the detection of iron deficiency and its causes.

Percentage values given in parentheses are percentages of the values in the previous line.

Grahic Jump Location




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