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

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.