Figure 2 shows the clinical complications of hemochro-matosis. Complications of heart failure such as shortness of breath, fatigue, and edema of the ankles as well as other symptoms and signs of heart failure occur. Palpitations caused by arrhythmias may be bothersome and serious arrhythmias can cause death. Signs and symptoms due to other organ involvement include pigmentation of the skin, diabetes because of involvement of the pancreas, enlargement of the liver and cirrhosis may cause fluid to accumulate in the abdomen, and ascites and cancer of the liver may be terminal. Arthritis may be severe with
C. Diagnosis
Serum ferritin, normally 16–320 mg/L is usually elevated to more than 700 mg/L and may reach as high as 5000 mg/L. A liver biopsy usually confirms the type of damage caused by hemochromatosis and the genetic causation is con¬firmed by gene testing.
Disturbance in the heart can be detected by echo-cardiography or radionuclide ventriculography, both of which show left ventricular dysfunction. The MRI is more specific; iron that is localized in the myocardium and liver generates a characteristic signal dropout pattern so that the liver and in part, the myocardium, become invisible.

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