Current Issue
Vol. 7, No. 1
Jan–Feb 2001
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Letter
Iron Loading and Disease Surveillance
To the Editor: We read with interest the article by E. D. Weinberg entitled
"Iron Loading and Disease Surveillance" (1). Dr. Weinberg proposes
routine population screening of iron values by serum ferritin and transferrin saturation tests. Such screening could provide valuable information for
epidemiologic, diagnostic, prophylactic, and therapeutic studies of emerging infectious diseases. However, population screening for hereditary
hemochromatosis, the example Dr. Weinberg uses to illustrate his proposal, should await additional data
(2-4). At this time, it is not known how
many people with genetic risk or biochemical evidence of iron overload will actually become ill. Therefore, the benefits of screening cannot be
weighed against the risks of unnecessary treatment. Moreover, standardized, reliable methods for measuring and diagnosing iron overload are not
available.
Without additional data, population screening can actually be detrimental to those at risk for disease. Persons with hereditary hemochromatosis may
face discrimination, including difficulties in acquiring health, life, or disability insurance. Already, current blood safety policy makes it difficult for
them to donate blood, even though blood donation is unlikely to have negative consequences. In addition, the costs of screening for hemochromatosis
are not routinely covered by medical insurance nor has the cost-effectiveness of screening been determined. If routine screening is adopted, tracking
of persons who test positive must be developed to ensure that appropriate and continuing follow-up is provided and patient confidentiality is
preserved.
The Centers for Disease Control and Prevention recommends testing for persons who have either a close relative with hemochromatosis or who
themselves experience the unexplained symptoms compatible with the disease (severe weakness or fatigue; unexplained joint or abdominal pain) or
its later complications (liver disease, diabetes, or heart problems; impotence; infertility; loss of menstrual periods)
(2,5). Testing to exclude other
causes of these medical problems should also be performed. Persons with elevated iron or liver function measures should be monitored by their
health-care provider.
Michele Reyes and Giuseppina Imperatore
Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
References
- Weinberg ED. Iron loading and disease surveillance. Emerg Infect Dis 1999;5:346-52.
- Cogswell ME, Mc Donnell SM, Khoury MJ, Franks AL, Burke W, Brittenham G. Iron overload, public health, and genetics:
evaluating the
evidence for hemochromatosis screening. Ann Intern Med 1998;129(Suppl 11);971-9.
- Cogswell ME, Burke W, McDonnell SM, Franks AL. Screening for
hemochromatosis. A public health perspective. Am J Prev Med 1999;16:134-40.
- EASL International Consensus Conference on
Haemochromatosis. J Hepatol 2000;33:485-504.
- Witte DL, Crosby WH, Edwards CQ, Fairbanks VF, Mitros FA. Practice guideline development task force of the College of American
Pathologists. Hereditary
hemochromatosis. Clin Chim Acta 1996;245:139-200.
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