Lurking pandemic - Hemochromatosis.

cnarf · 24-06-2009 12:15am

Micky 32 wrote: »

We recently found out that our family on my fathers side were carriers. For someone to have the illness do both parents have to be carriers?

Carriers cn have some milder symptoms. My husband was identified as a carrier some years ago. Recently blood tests showed raised ferritin levels. he is in his late 50s

Goldenquick · 29-04-2010 1:53pm

DrIndy wrote: »

the good news for haemachromatosis is that the blood bank in ireland after a DECADE of campaigning has finally woken up.

People with haemachromatosis need to have up 100 units of blood taken off to reduce the iron load (sometimes even more!) over 1-2 years and then maintenance treatment. They used to throw the blood in the bin because the transfusion board would only accept voluntary donations.

Thankfully now they are starting to accept this blood which is perfectly normal and usable to treat people with.

So your illness and your difficulties now can be used to save tens, even hundreds of patients which is a wonderful contre-coup.

Do you know if the blood is being used for transfusions now, my husband has recently been diagnosed with this condition but as far as I know they are getting rid of the blood taken off him.

joestingle · 14-05-2010 1:29pm

The list actually goes on. There was a time when victims of this condition were often labeled "hypochondriac", and not long after such diagnosis they would die due to failure of one of the major organs.

This condition is a hereditary genetic mutation, and it is most common in peoples of northern European descent, but in particular those with Irish roots.

crazy dude · 15-05-2010 3:31pm

The Dr00g wrote: »

I read a theory that the mutated gene/s could have been caused by a dangerously low iron diet in some of the northern European peoples that the Irish predominantly descend from.

I think in the irish climate many bacterial infections existed in the ancient world where the bacteria thrived on Iron in the colon from diet so it made sense to evolve better iron transport in our guts

crazy dude · 15-05-2010 3:57pm

Another risk factor in Ireland is the recommendation of mega doses of vitamin C for winter colds. Vit C is really good at enhancing iron absorption in the gut it seems. The practise of taking vitamin C was started by Linaeus Pauling who won the noble prize for the structure of myoglobin and his fame lent wait to a small study in skiers he undertook one winter. Then an Irish pharmacologist popularised this idea with doctors, nurses and pharmacists here so it became fact in irish medicine although theres no evidence it actually prevents colds and no reasonable explanation why it should work

DrIndy · 16-05-2010 3:58am

In fairness for people with haemachromatosis - people think they should have a low iron diet - but in the end what happens is they end up nutrionally depleted because they are eating an unbalanced diet. Most clinics advocate to keep doing and eating well and if needs be - take off an extra unit or two over the year.

Contact the IBTS for information on blood donating your units taken off - this is still a pilot service in many ways and may only be offered in certain parts of the country for now and the initial plan for them was to accept blood for the maintenance phase rather than the actual depletion phase which is where most of the blood is removed.

joestingle · 21-05-2010 11:51am

Late diagnosis of Hemochromatosis can mean that you do end up with liver and kidney problems as well as possible diabetes so all this means that you have to be alert. Thankfully there is treatment for Hemochromatosis and you can get this treatment simply from going to the doctor every couple of weeks and then you can get back to being yourself again.So please take care if you suffering from this.

BostonB · 21-05-2010 12:16pm

Is there any Irish support/info group for this?

locum-motion · 21-05-2010 12:43pm

BostonB wrote: »

Is there any Irish support/info group for this?

Irish Haemochromatosis Association.

http://www.haemochromatosis-ir.com/

BostonB · 21-05-2010 12:44pm

Ah cheers...

huber · 16-06-2010 2:53pm

Hi

Can anyone tell me the difference between saturation levels and feretin levels? My mm has been getting her blood taken off to reduce her feretin levels but now the doctor told her the other day that her saturation levels are over 80, anyone know anything about this?

Sitric · 16-06-2010 8:09pm

Hey huber,

Ferritin is the soluble storage form of iron, the value in your blood gives you an indication of the amount of iron stored in cells in your bone marrow. These cells are called bone macrophages.

Saturation refers to the percentage of serum transferrin bound to iron.

Transferrin is the protein iron binds to in your blood. Serum is like blood plasma without the clotting factors.

Usually about 1/3 of this protein is bound to iron so if it's higher it usually means an iron overload disease.

You should get your mum to ask her doctor about this.

wayhey · 21-06-2010 11:52am

Is it true we could use the blood taken from haemochromatosis patients in blood transfusions?

crazy dude · 04-08-2010 8:55pm

Was anyone else at the talk given the year (2005) TCD hosted the British Association Science Fair and Prof Scott hosted a talk about haemachromatosis? A female doctor from James talked about the huge clientele they get from all along James Street into town with haemachromatosis.It wasn't so much the genetics as the precipitants of the clinical condidtion. She was studying the cause of this cluster and her two hypotheses were:
(A) Guinesses is along the route and therefore a popular local beverage with lots of Iron
(B) The route is mobbed with pharmacies and irish pharmacies sell Vitamin C in megadoses for colds( based on the teachings of Linaeus Pauling (study he did in skiers) and a famous irish professor of Pharmacology (cedric Wilson ???) who advocated it to medical and pharmacy students in the 1960s). Vitamin C is thought to increase iron absorption eg ferrograd C and this use of Vitamin C as prophylaxis for the common cold is meant to be a uniquely Irish medical practice( Sort of Prof told us so lets not question it and so on until it has become medical fact almost)

So I was wondering did anyone ever hear whether she proved either of these two factors to have aggrevated the situation in Ireland or were these hypotheses not proven ????

locum-motion · 04-08-2010 10:47pm

A: No matter how much Guinness you drink, it's not going to give you haemochromatosis if you don't have haemochromatosis. However, if someone does have haemochromatosis, eating/drinking lots of iron rich foods and drinks is going to cause a quicker rise of iron level than would be seen in someone who does't eat/drink lots of iron. Anyway, just because it's made locally, I can see no reason to think that the local population drink more Guinness per capita than the population of say Cork, New York, Gortahork or Glenamaddy (OK, maybe not New York!).
B: I don't think there's any more pharmacies along James St, Thomas St etc than there is along any other comparable route into town, say Camden St/Wicklow St, Amiens St, Dorset St/Capel St etc. Even if there was, what evidence was there that they sold any more or less Vitamin C than any other arbitrary set of pharmacies in the country?

I think the most likely reason why a doctor from James' Hospital saw lots of haemochromatosis patients from James St, is that she was a doctor in James' hospital! Same as a doctor in the Lourdes Hospital will see lots of haemochromatosis patients from Drogheda.

crazy dude wrote: »

Was anyone else at the talk given the year (2005) TCD hosted the British Association Science Fair and Prof Scott hosted a talk about haemachromatosis? A female doctor from James talked about the huge clientele they get from all along James Street into town with haemachromatosis.It wasn't so much the genetics as the precipitants of the clinical condidtion. She was studying the cause of this cluster and her two hypotheses were:
(A) Guinesses is along the route and therefore a popular local beverage with lots of Iron
(B) The route is mobbed with pharmacies and irish pharmacies sell Vitamin C in megadoses for colds( based on the teachings of Linaeus Pauling (study he did in skiers) and a famous irish professor of Pharmacology (cedric Wilson ???) who advocated it to medical and pharmacy students in the 1960s). Vitamin C is thought to increase iron absorption eg ferrograd C and this use of Vitamin C as prophylaxis for the common cold is meant to be a uniquely Irish medical practice( Sort of Prof told us so lets not question it and so on until it has become medical fact almost)

So I was wondering did anyone ever hear whether she proved either of these two factors to have aggrevated the situation in Ireland or were these hypotheses not proven ????

yerayeah · 05-08-2010 1:30am

Does anyone know what the story with Guinness and iron is?! I was told the reason for the strong smelling, dark feacal matter :P that often arrives the morning after a night on the Guinness is due to iron being broken down, so it's basically the same principle as melaena. However when you google the iron content of Guinness it seems that this high iron content is a bit of an urban myth. Anyone have a definitive answer on this?!

Also, I doubt that vit C being used as prophylaxis of the common cold is an Irish thing because there's been enough research into it to conduct a Cochrane analysis into it. (No benefit over placebo for prevention, small benefit for treatment were the findings I think).

Tar.Aldarion · 05-08-2010 4:11am

I have this, not really a troublesome thing, tests are grand and easy enough to keep yourself in check. /releases blood. Rather this than a lot of other ailments! Wondering how little iron you could eat with this vs a balanced diet etc.

huggs2 · 05-08-2010 9:21am

yerayeah wrote: »

Does anyone know what the story with Guinness and iron is?! I was told the reason for the strong smelling, dark feacal matter :P that often arrives the morning after a night on the Guinness is due to iron being broken down, so it's basically the same principle as melaena. However when you google the iron content of Guinness it seems that this high iron content is a bit of an urban myth. Anyone have a definitive answer on this?!

Also, I doubt that vit C being used as prophylaxis of the common cold is an Irish thing because there's been enough research into it to conduct a Cochrane analysis into it. (No benefit over placebo for prevention, small benefit for treatment were the findings I think).

This might help.
http://www.dailymail.co.uk/health/article-1222684/Dont-believe-say--Guinness-isnt-good-you.html

NattyRasher · 16-02-2011 3:42pm

Hi everyone,

All the information on the thread is great but I have a question that no one seems to have dicussed yet.

My boyfriends mother was recently told she was a sufferer. She was only tested because one of her brothers was found to have the same problem. It now turns out that several of the family on that side are sufferers. My boyfriend although extremely fit and healthy suffers with joint pain and a feeling of being tired quite frequently and so he was going to go get tested.
The problem is that my boyfriends mother has told him that her brother (confusing I know) has said that if he gets tested and is found to be positive that he can not be approved for a mortgage.
Has anyone else heard of this being true or even a possibility?

pablo21 · 16-02-2011 3:45pm

NattyRasher wrote: »

Hi everyone,

All the information on the thread is great but I have a question that no one seems to have dicussed yet.

My boyfriends mother was recently told she was a sufferer. She was only tested because one of her brothers was found to have the same problem. It now turns out that several of the family on that side are sufferers. My boyfriend although extremely fit and healthy suffers with joint pain and a feeling of being tired quite frequently and so he was going to go get tested.
The problem is that my boyfriends mother has told him that her brother (confusing I know) has said that if he gets tested and is found to be positive that he can not be approved for a mortgage.
Has anyone else heard of this being true or even a possibility?

Absolute rubbish I would imagine. I got a mortgage, in fact 2 mortgages.

enda1 · 16-02-2011 3:50pm

Knew of a man who died of this.

His GP thought he was anaemic so advised an iron rich diet!

pablo21 · 16-02-2011 3:59pm

My iron countwas about 5 or 600, nothing too crazy but my dad's was over 15,000. They reckon he had one of the highest iron counts in the country! And to add insult to injury, his doctor had put him on iron supplements!! Lucky it didnt kill him...

NattyRasher · 16-02-2011 4:34pm

Thanks pablo21.
We kind of figured it's probably rubbish but my boyfriend doesn't want to get tested in case he is positive and then we can't get a mortgage in the future.
If I may be so bold, can I ask if you got both your mortgages before or after you found out you were a sufferer? Or if you recall (which you probably wouldn't) whether or not it was one of those illnesses you need to inform your mortgage provider about?

pablo21 · 16-02-2011 4:40pm

NattyRasher wrote: »

Thanks pablo21.
We kind of figured it's probably rubbish but my boyfriend doesn't want to get tested in case he is positive and then we can't get a mortgage in the future.
If I may be so bold, can I ask if you got both your mortgages before or after you found out you were a sufferer? Or if you recall (which you probably wouldn't) whether or not it was one of those illnesses you need to inform your mortgage provider about?

Well the first thing I would say is definitely get tested and get the correct treatment underway asap. I personally dont believe the full effects of Haemochromotosis are fully understood yet so at a very minimum get the iron levels down. I did inform the bank about it at the time and it had no impact on banks/life insurance/health insurance etc.

NattyRasher · 16-02-2011 4:51pm

That's great, thanks for getting back to me.
It seems to be very prevalent in his family so I can start bugging him to go get tested now

opinion guy · 21-02-2011 5:30pm

NattyRasher wrote: »

Thanks pablo21.
We kind of figured it's probably rubbish but my boyfriend doesn't want to get tested in case he is positive and then we can't get a mortgage in the future.
If I may be so bold, can I ask if you got both your mortgages before or after you found out you were a sufferer? Or if you recall (which you probably wouldn't) whether or not it was one of those illnesses you need to inform your mortgage provider about?

pablo21 wrote: »

Well the first thing I would say is definitely get tested and get the correct treatment underway asap. I personally dont believe the full effects of Haemochromotosis are fully understood yet so at a very minimum get the iron levels down. I did inform the bank about it at the time and it had no impact on banks/life insurance/health insurance etc.

Jaysus if a bank of insurere refused to cover you because of haemchromatosis get straight on to Joe Duffy -it affects alot of people.

Oh I just stumbled upon this:
http://www.haemochromatosis-ir.com/

maninasia · 26-02-2011 1:22pm

crazy dude wrote: »

I think in the irish climate many bacterial infections existed in the ancient world where the bacteria thrived on Iron in the colon from diet so it made sense to evolve better iron transport in our guts

I've no clue about this disease but some mutations are common in a population simply because of the 'founder effect', one of the earliest migrants into Ireland may have had this mutation and then it became established in the population. For some of these diseases carriers may have an advantage in certain conditions, usually people with both disease alleles would be worse off but carriers outnumber full disease carriers so it stays in the population.
Some of these type of diseases also become prevalent in isolated populations or due to excessive inbreeding like Ashkenazi Jews or the British royal family.
Just as a general comment many of these diseases seem to be related to pathogen protection, my bet would be high iron in the blood somehow interferes with a severe bacterial disease that was present 1000s to 100s of years ago.

Tar.Aldarion · 26-02-2011 2:02pm

I imagine there was a lack of availability of iron back then

Tree · 26-02-2011 4:20pm

Aye, the evolution of haemochromatosis in the celts/scandanavians has been linked with a diet that is low in iron, so storing when it's available made sense. Today we have plenty of access to iron so it's no longer a useful mutation.

maninasia · 01-03-2011 4:50am

I think our records of diet and historical pandemic conditions are very poor, I'd be wary about drawing a 'just so' conclusion. So it could be diet related, it could be disease related, or it could simply be a founder effect mutation.

Tar.Aldarion · 01-03-2011 9:41pm

Tree wrote: »

Aye, the evolution of haemochromatosis in the celts/scandanavians has been linked with a diet that is low in iron, so storing when it's available made sense. Today we have plenty of access to iron so it's no longer a useful mutation.

I think it is quite useful, we just need to evolve to not need any nutrients now

Tree · 01-03-2011 11:25pm

maninasia wrote: »

I think our records of diet and historical pandemic conditions are very poor, I'd be wary about drawing a 'just so' conclusion. So it could be diet related, it could be disease related, or it could simply be a founder effect mutation.

I wouldnt reckon on the disease cause myself. Microbes do like the iron, so having a bunch of it knocking around for them to use readilly is unlikely, they dont belong in the blood, so why encourage them.

Diet is a more likely scenario imo (and in the opinions that i've read and from my lecturers on the topic). Increased storage of a nutrient would be beneficial if it were in short supply at somepoint.

maninasia · 02-03-2011 7:14am

Well plague bacteria seemed to like the iron just like you said...a topical article!
So how many deaths of unknown causes could have been linked with hemochromatosis, a lot I guess.

http://www.newscientist.com/blogs/shortsharpscience/2011/03/plague-scientist-died-of-the-plague.html

Worztron · 04-03-2011 1:58pm

Can someone with haemochromatosis donate blood or is all the blood simply dumped? I heard from someone before that anaemics can get blood donations from people with haemochromatosis – is that true?

El_Dangeroso · 04-03-2011 10:14pm

Tree wrote: »

Aye, the evolution of haemochromatosis in the celts/scandanavians has been linked with a diet that is low in iron, so storing when it's available made sense. Today we have plenty of access to iron so it's no longer a useful mutation.

Do you have any links to the low dietary Iron thing? I'm always interested in any data on early Irish diets. The data I've found is a bit sparse but their diet seems to be largely meat-based. Also I think the normal body absorbs roughly 10% of the iron in food and if it needs more, it can absorb more, so I remember from the nutrition chapter of my leaving cert home-economics book circa 1999! This would negate the survival advantage of having a gene that caused an inability of the iron stores to properly control the absorption of iron, as occurs in individuals without haemochomatosis.

maninasia · 05-03-2011 5:00pm

maninasia wrote: »

Well plague bacteria seemed to like the iron just like you said...a topical article!
So how many deaths of unknown causes could have been linked with hemochromatosis, a lot I guess.

http://www.newscientist.com/blogs/shortsharpscience/2011/03/plague-scientist-died-of-the-plague.html

The causes are probably more complex than we can guess right now. For instance take the fact that iron affects bacterial growth theory. A poster earlier mentioned that increased iron transport into the blood would be useful to reduce iron levels in the gut and hence decrease growth of bacteria in the colon. But that then seems to make blood borne bacterial infections, like plague, more likely (as in my link here).
I think the key is in the carriers, not the full blown hemochromtosis sufferers, check their average levels of iron.

Tar.Aldarion · 05-03-2011 5:05pm

Worztron wrote: »

Can someone with haemochromatosis donate blood or is all the blood simply dumped? I heard from someone before that anaemics can get blood donations from people with haemochromatosis – is that true?

I think it is used for donations these days, that's what i heard anyway!
Also a lot of us would just have normal iron levels in their blood like me anyway?

I think you an donate anyhow, which would be a good way of removing some blood from yourself

Tree · 06-03-2011 12:44am

El_Dangeroso wrote: »

Do you have any links to the low dietary Iron thing? I'm always interested in any data on early Irish diets. The data I've found is a bit sparse but their diet seems to be largely meat-based. Also I think the normal body absorbs roughly 10% of the iron in food and if it needs more, it can absorb more, so I remember from the nutrition chapter of my leaving cert home-economics book circa 1999! This would negate the survival advantage of having a gene that caused an inability of the iron stores to properly control the absorption of iron, as occurs in individuals without haemochomatosis.

You can absorb a maximum of 3mg of iron a day afair, can't find the ref. It's been estimated a max of 10% of food iron can be absorbed. But the mechanism for transporting iron can be saturated, that's why teh 3mg ish max can happen. (there's active transport across the duodenal villi and even those cell can handle a certain amount of iron before they give up and slough off into the gut).

Srai, SKS., Bomford, A. & McArdle, HJ. (2002) Iron transport across cell membranes: molecular understanding of duodenal and placental iron uptake. Best Practice & Research Clinical Haematology, 15, 243-259 might be the relevant link. Just had a look at a lit review i did last year.

taram · 06-03-2011 1:18am

maninasia wrote: »

I think the key is in the carriers, not the full blown hemochromtosis sufferers, check their average levels of iron.

Out of curiosity, why? I'm a carrier, and I always have high iron when I donate blood, or have blood tests: I'm also a veggie who doesn't eat a particularly high in iron diet to begin with.

Worztron · 06-03-2011 9:52am

taram wrote: »

Out of curiosity, why? I'm a carrier, and I always have high iron when I donate blood, or have blood tests: I'm also a veggie who doesn't eat a particularly high in iron diet to begin with.

Is it practically impossible for someone with haemochromatosis to become anaemic?

El_Dangeroso · 06-03-2011 12:24pm

Tree wrote: »

You can absorb a maximum of 3mg of iron a day afair, can't find the ref. It's been estimated a max of 10% of food iron can be absorbed. But the mechanism for transporting iron can be saturated, that's why teh 3mg ish max can happen. (there's active transport across the duodenal villi and even those cell can handle a certain amount of iron before they give up and slough off into the gut).

Srai, SKS., Bomford, A. & McArdle, HJ. (2002) Iron transport across cell membranes: molecular understanding of duodenal and placental iron uptake. Best Practice & Research Clinical Haematology, 15, 243-259 might be the relevant link. Just had a look at a lit review i did last year.

I can't get the fulltext of that paper, can you highlight where it says 10% was the max absorption, as everything else I've read says that's the average, with the body absorbing more if it needs more.

http://bloodjournal.hematologylibrary.org/cgi/reprint/84/6/1697.pdf

There are situations in which larger amounts of dietary
iron are absorbed than can be attributed to the store-regula-
tor. For example, phlebotomized subjects on a normal diet
have been shown by balance studies to replace 3 to 4 mg of
iron loss in addition to their excretory loss. 31, 32

Even if 3mg iron a day is the saturation point in some people people but I don't see how absorbing more is a survival advantage? Unless of course the bacterial or parasitic hypothesis of haemochromatosis is true. Or possibly if a lot of blood loss was commonplace.

The low-dietary iron theory just doesn't seem like a realistic explanation to me.

Tree · 06-03-2011 5:57pm

you dont normally absorb at the saturation rate, you only aborb 1to2mg for losses. You only absorb at the maximal saturation rate if your regulation is gandered (haemochromatosis) or if you have higher than normal losses (bleeding/being female).

There's no beneifit to absorbing excess as there is no excretory mechanisms to counteract the toxicity. So the absorbtion mechanism is generally tightly controlled.

Also, that 10% is an estimate. It would vary w/ diet, but that's assuming 30mg of iron in the daily diet. Dont have time to be pulling information out of that ref, sorry.

El_Dangeroso · 06-03-2011 8:12pm

Tree wrote: »

you dont normally absorb at the saturation rate, you only aborb 1to2mg for losses. You only absorb at the maximal saturation rate if your regulation is gandered (haemochromatosis) or if you have higher than normal losses (bleeding/being female).

There's no beneifit to absorbing excess as there is no excretory mechanisms to counteract the toxicity. So the absorbtion mechanism is generally tightly controlled.

Also, that 10% is an estimate. It would vary w/ diet, but that's assuming 30mg of iron in the daily diet. Dont have time to be pulling information out of that ref, sorry.

Yeah, but that's what I'm saying, the absorption method is tightly controlled in those without HC, so where's the evolutionary advantage to losing that tight regulation as is the case with HC? I'm not saying it can't be the case, these are all guesses after all, but I really doubt low dietary iron is the most parsimonious hypothesis given the facts we do know.

Worztron · 07-03-2011 10:43am

If someone was a vegan or vegetarian and discovered that they had haemochromatosis, would that be advantageuos to them?

Tar.Aldarion · 07-03-2011 1:17pm

Worztron wrote: »

If someone was a vegan or vegetarian and discovered that they had haemochromatosis, would that be advantageuos to them?

My doctor suggested vegetarianism to me when I was diagnosed, I already was one. It would be since you may eat less iron than people that eat meat, then again a vegan or vegetarian could eat more iron, it just depends what they eat. In general I'd say it could turn out handy.

maninasia · 07-03-2011 2:58pm

taram wrote: »

Out of curiosity, why? I'm a carrier, and I always have high iron when I donate blood, or have blood tests: I'm also a veggie who doesn't eat a particularly high in iron diet to begin with.

I can see there are some people who are experts in this disease on here, they should be able to give a good idea as to effects on carriers. Why I say 'carriers' are the key is they usually outnumber full disease sufferers by a factor of 100s to 1000s of times (if it is the type of disease that needs two disease copies to express itself..like autosomal recessive diseases as opposed to autosomal dominant).

In some inherited genetic diseases carriers show no effect whatsoever but in many inherited genetic diseases carriers will have a slightly different 'expression than the normal population but not enough to cause serious disease.

Autosomal Recessive (need two defective copies for the disease to appear)
Autosomal Dominant (only one copy of the gene can cause the disease to appear)
http://en.wikipedia.org/wiki/Dominance_(genetics)#Dominant_and_recessive_genetic_diseases_in_humans

Every genetic disease is different and it's hard to generalise, this one is complicated again because the ill effects don't turn up until you are older and already reproduced, so that is why I said it is also possible it is simply a 'founder effect', an unlucky coincidence of timing and nature. Since an estimated 33% of the population in Ireland are supposed to be carriers I think it was simply introduced extremely early in the gene pool in Ireland.

Just thinking of the top of my head there may be a way to very roughly test this theory, if more people in the West of Ireland have this disease than the rest of the country.

BostonB · 07-03-2011 3:03pm

Worztron wrote: »

Is it practically impossible for someone with haemochromatosis to become anaemic?

I know someonw who is a carrier, and a tendancy to be anaemic.

Tar.Aldarion · 07-03-2011 4:23pm

BostonB wrote: »

I know someonw who is a carrier, and a tendancy to be anaemic.

My mother carries it and has to take iron injections a lot etc

Worztron · 07-03-2011 7:15pm

BostonB wrote: »

I know someonw who is a carrier, and a tendancy to be anaemic.

But they are only carriers and don't have haemochromatosis, therefore they wont suffer from iron overload.

BostonB · 08-03-2011 12:24am

From what I've read it would be unusual but not impossible. Any carriers I know have their iron monitored.

Lurking pandemic - Hemochromatosis.

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