Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of hereditary hemochromatosis with established cirrhosis. Reports progressive fatigue, arthralgia (predominantly 2nd/3rd MCP joints), and abdominal distension. Denies hematemesis, melena, or confusion. Current iron overload status monitored via serial ferritin levels. Compliance with phlebotomy schedule or iron chelation therapy confirmed.
Clinical Examination Findings
Vitals stable. Skin: hyperpigmentation (bronze skin) noted. HEENT: scleral icterus absent. Abdomen: hepatomegaly with firm, nodular liver edge; mild ascites present; no splenomegaly. Extremities: trace pedal edema, arthropathy of MCP joints with limited range of motion. Neurological: alert and oriented, no asterixis.
Treatment Protocol
Continue therapeutic phlebotomy (frequency: [X] times/week) to maintain serum ferritin < 50 ng/mL. Monitor CBC and iron studies monthly. Maintain low-iron diet; avoid iron-fortified foods and vitamin C supplements. Hepatology follow-up for cirrhosis surveillance, including biannual abdominal ultrasound and alpha-fetoprotein (AFP) screening for hepatocellular carcinoma.