Background

Hereditary hemochromatosis is a genetic disorder that is divided into 4 types. The most common is type I, an HFE gene mutation resulting in cysteine-to-tyrosine substitution at gene 282 (C282Y) or less frequently an aspartate-to-histidine substitution at gene 63 (H63D). This condition results in a dysfunction of hepcidin, a protein that inhibits the absorption of excess iron. The excess iron is then stored in various organs especially the liver, pancreas and heart. This can lead to problems such as cirrhosis, diabetes, and heart failure, it can even affect fertility. Hereditary hemochromatosis is more common in men of Northern European descent but will often manifest in post-menopausal women. Approximately 0.5 percent of the population carries the autosomal recessive HFE C282Y variant. The treatment for hemochromatosis is serial phlebotomy along with monitoring transferrin saturation and ferritin levels every 4 to 12 weeks. Cases have been documented of patients undergoing bariatric surgery for weight loss with hereditary hemochromatosis. In many of these instances the patients who underwent gastric bypass were able to either decrease their frequency of serial phlebotomy or stop it altogether. In this review, we discuss the documented cases of patients who underwent various types of bariatric surgery, their clinical course with regards to hereditary hemochromatosis and the unexpected butterfly effect they experienced of being able to stop frequently cumbersome and costly therapeutic treatments.