From the Guidelines
Hemochromatosis can cause elevated liver enzymes due to iron overload and subsequent liver cell injury. Hemochromatosis is a genetic disorder characterized by elevated transferrin saturation and progressive iron loading that mainly affects the liver, as stated in the EASL clinical practice guidelines on haemochromatosis 1. The excess iron accumulation in liver tissue can lead to inflammation and damage to liver cells, resulting in elevated liver enzymes such as ALT and AST. These elevated enzymes are markers of liver cell injury. According to the guidelines, early diagnosis and treatment by phlebotomy can prevent cirrhosis, hepatocellular carcinoma, diabetes, arthropathy, and other complications 1.
The liver damage occurs because excess iron generates harmful free radicals that damage cell membranes, proteins, and DNA. Key points to consider in the diagnosis of haemochromatosis include:
- Elevated transferrin saturation (TSAT) and ferritin levels
- Presence of hepatic iron overload on MRI or liver biopsy in patients with high TSAT and elevated ferritin but other HFE genotypes
- Assessment of the stage of liver fibrosis and other end-organ damage at diagnosis
- Inclusion of patients with advanced fibrosis in a screening programme for hepatocellular carcinoma, as recommended by the EASL guidelines 1.
Regular monitoring of liver enzymes is important for patients with hemochromatosis, and treatment primarily involves phlebotomy to reduce iron levels, which can help normalize liver enzymes and prevent further liver damage. The treatment targets for phlebotomy are ferritin <50 µg/L during the induction phase and <100 µg/L during the maintenance phase, as outlined in the EASL guidelines 1.
From the Research
Hemochromatosis and Elevated Liver Enzymes
- Hemochromatosis is a genetic disorder characterized by excessive iron overload in the body, which can lead to liver damage and elevated liver enzymes 2, 3.
- Studies have shown that patients with hemochromatosis often have mild abnormalities in their liver profile, including elevated levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 2.
- In fact, one study found that more than 65% of patients with hemochromatosis had mild abnormalities in their AST and ALT levels 2.
- Patients with cirrhosis due to hemochromatosis tend to have more significant elevations in AST, ALT, and alkaline phosphatase, as well as decreased albumin levels 2.
- The liver plays a central role in maintaining normal systemic iron homeostasis, and excess iron storage in the liver can lead to the development of disease in this organ 3.
Diagnosis and Screening
- Routine laboratory tests, including serum AST, ALT, alkaline phosphatase, and bilirubin levels, can be useful in screening for liver disease and monitoring its progression 4.
- Early diagnosis of hemochromatosis is crucial, and primary care and hospital medicine physicians play an essential role in identifying this condition through standard hematologic testing 5.
- Screening for hemochromatosis with serum ferritin and transferrin saturation can help identify patients with unexplained abnormalities in their liver profile 2.