Iron Overload cases

1. A 48 year old man is sent for evaluation of abnormal iron

studies. Ferritin 3500ng/l. For the past 3 years he has
complained of chronic fatigue and progressive arthralgias of
the second and third MP joints. He has recently been
diagnosed with glucose intolerance. He is otherwise healthy
and takes no medication. He is a non smoker and social
drinker. His father died of cirrhosis at age 63 and was not
alcoholic.
a. What is important in the history that may have lead to
an earlier diagnosis?
b. How is it important?
On examination he is caucasian but seems to have a heavy tan (he
denies heavy sunbathing), he has hepatomegaly 3cm below right
costal margin. His FBC is normal, fasting blood glucose is 10mmol/l,
Iron saturation is 79%, serum ferritin 1997ng/ml. His son is a healthy
teenager.
c. What is important in the examination?
d. Is there any evidence of possible organ damageorgan
damage?
e. What major organ will you need to check?
f. What is the probable diagnosis?
g. What would be the treatment?
h. What advice will you give regarding the son.
2. a. How should a multiplied transfused patient with a ferritin
level of 2000 ng/ml and on-going transfusions be managed
b. What organs should be monitored and what investigations
would be needed to do this?