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Suggest Treatment For Hemochromatosis And Hepatitis B Infection

Posted on Tue, 14 Jul 2015

Question: Is there any treatment once an MRI shows iron overload in the liver in a patient with chronic hepatitis B? Meaning a way to reduce the level of iron? No known history of family issues with iron overload. He has had it for 25+ years. Is on Baraclude. Liver function tests normal. Tumor markers negative. Nodules seen on MRI but no indication of masses or lesions. I am awaiting a copy of the MRI report. Viral loads below detection for quantifying. Fibroscore puts him at stage F3. With necroinflamation score of no activity.
Recently now positive for one other Heb B test...which doc says may indicate body attempting to seroconvert
Hep BE AB - Positive ....was previously negative but now positive last 2 tests.
Hep BE AG - Positive
Hbsag Screen - Positive
Hepatitis B Surface Antibody Quant <3.1
MRI results:

Study limited my motion - Study is markedly degraded - this is very upsetting as I had him sedated for procedure to ensure a good study.

Heptobiliary: Liver Mildly modular, suggestive of cirrhosis. Liver is low in signal intensity, suggestive of hemochromatosis. Transient hepatic intensity differences are noted throughout the left lobe of the liver. Heterogeneity of the hepatic parenchyma makes it difficult to evaluate for a focal enhancing lesion. No large enhancing lesions are identified.

Peritoneum/Mesentery/Bowel: No Bowel Obstruction, bowel wall thickening or mesenteric inflammatory process.

Spleen, pan crease, adrenal glands, kidneys unremarkable.

Bone/Soft Tissue No focal aggressive osseous lesions are present

Impression
Motion degraded study
Somewhat nodular liver
Low signal intensity liver, suggestive of hemochromatosis
No large focal hepatic lesions.

Answered by Dr. Shailja Puri (30 hours later)

Brief Answer:
Presence of hemochromatosis and hepatitis B infection, app tt required

Detailed Answer:
Hello,
Thanks for posting your query on HealthcareMagic.
The MRI shows nodules in liver suggestive of hemochromatosis which is an iron overload disease and it eventually leads to liver cirrhosis.
Hemochromatosis is managed by avoiding iron overload in body by iron chelation therapy.
Once damage to visceral organs occurs, its effect is irreversible.
The MRI is limited by movement of your husband.
In addition to hemochromatosis, there is active hepatitis B infection.
The HBeAb and HBeAg should be repeated after few weeks.
Disappearance of HBeAg should occur and indicates clearance of hepatitis B virus from body.
The Fibroscan is showing fibrosis of liver parenchyma upto grade 3 which is a high grade.
Fibrosis is expected in iron deposition.
However, there is no inflammation and its absence is good for the health of the liver.
Further management depends on the functional capacity of liver.
Liver transplant is the definitive treatment for the condition.
Stay in touch with your hepatologist for further management.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shailja Puri (1 hour later)

For chronic Hep B is hemochromatosis a side effect or a separate issue. I have read that this can be hereditary especially in the U.S. This is my brother who is disabled not my husband. My iron panel shows elevate ferritin, low TIBC, low UIBC, and transferrin with normal iron level. Does it make sense to treat with iron chelation therapy in the presence of chronic Hep B. Should I have his iron panel repeated first and then discuss options for iron chelation. Or is its presence in the liver enough to indicate treatment.

I have read that iron build up in liver with Hep B can help feed the disease and make it worse?

Answered by Dr. Shailja Puri (26 minutes later)

Brief Answer:
Hemochromatosis and hepatitis B infection are different issues

Detailed Answer:
Hello and welcome again,
I am sorry for wrong salutation.
Hemochromatosis and infection with hepatitis B virus are two different issues.
Hemochromatosis is a hereditary condition whereas hepatitis B virus is an infection.
Hepatitis B infection can spread by needle prick, by sexual contact and from infected mother to child.
Superimposed Hepatitis B infection can worsen a pre-existing liver disease like hemochromatosis.
Iron panel showing elevated ferritin, low TIBC and low UIBC are characteristic of iron overload.
Elevated ferritin level indicates iron load.
The excess iron in body deposits in organs and causes damage.
Thus, iron needs to be removed from body with iron chelation therapy.
However, the sad part is that the damage already caused is irreversible.
Hepatitis B infection needs to be monitored by serological tests- HBeAg and HBeAb, if HBeAg disappears then the infection has resolved and no treatment is required.

Thanks and take care
Dr Shailja Puri

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj