Neonatal hemochromatosis

Other Names: Idiopathic neonatal Hemochromatosis; NH; NHC; Neonatal hepatitis (formerly); Giant Cell Hepatitis (formerly); Hemochromatosis neonatal

Neonatal hemochromatosis is a disease in which too much iron builds up in the body. This is also called iron overload. Accumulation of iron in the organs is toxic and can cause organ damage.

In this form of hemochromatosis, the iron overload begins before birth. This disease tends to progress rapidly and is characterized by liver damage that is apparent at birth or in the first days of life. Babies with the disease may be born very early (premature) or struggle to grow in the womb (intrauterine growth restriction).

Cause

The exact cause of neonatal hemochromatosis is unknown. It is thought that women who have a baby with neonatal hemochromatosis may have an immune system that recognized the cells of the baby’s liver as foreign. The immune system is responsible for protecting people from infection. When a woman is pregnant, her immune system is supposed to protect both the mother and the baby from infection using antibodies (molecules that recognize infections). It is thought that in some cases, a woman’s immune system may direct antibodies against the baby’s liver cells. This causes the liver to be unable to absorb iron correctly. When the liver is damaged, too much iron collects in other tissues of the body. This leads to the signs and symptoms of neonatal hemochromatosis.

Inheritance

Neonatal hemochromatosis is not thought to be inherited. This means that changes in a specific gene are not thought to cause neonatal hemochromatosis. Instead, it is thought that the disease is caused by a woman’s immune system mistakenly directing antibodies against the cells of the baby’s liver. A woman who has had one baby with neonatal hemochromatosis may have an immune system with antibodies that are more likely to recognize the liver cells of a developing baby as foreign. Therefore, each future baby of a woman who has had one baby with neonatal hemochromatosis is at an 80% chance to have the disease as well.

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Signs and symptoms

Symptoms of neonatal hemochromatosis may include low blood sugar (hypoglycemia), abnormalities in blood clotting, yellowing of the skin and eyes (jaundice), and swelling (edema). For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed.

80%-99% of people have these symptoms

• Abnormal localization of kidney(Abnormal localisation of kidneys)
• Anteverted nares(Nasal tip, upturned)
• Aplasia/Hypoplasia of the nipples(Absent/small nipples)
• Blepharophimosis(Narrow opening between the eyelids)
• Congenital hepatic fibrosis(Excessive buildup of connective tissue and scarring of liver at birth)
• Hypoglycemia(Low blood sugar)
• Increased serum ferritin(Elevated serum ferritin)
• Increased serum iron
• Micrognathia(Little lower jaw)
• Prolonged neonatal jaundice(Prolonged yellowing of skin in newborn)
• Prominent nose(Big nose)

Diagnosis

A diagnosis of neonatal hemochromatosis is suspected when a doctor observes signs and symptoms of hemochromatosis or liver disease in a newborn. A doctor may decide to order laboratory tests including a liver biopsy, MRI, or blood test.

Treatment

Treatment options for neonatal hemochromatosis may include blood exchange transfusion and intravenous immunoglobulin (IVIG) therapy. These processes are aimed at removing excess iron from the blood. However, these treatments are only supportive and cannot cure the disease. In most cases, a liver transplant is necessary because babies with this disease have severe liver damage. Unfortunately, the symptoms and organ damage caused by neonatal hemochromatosis can be so severe that babies with the disease may not survive even with treatment. Women who have had a baby with neonatal hemochromatosis may be recommended to receive IVIG treatment in future pregnancies to prevent having other pregnancies affected with the disease.

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  Hemochromatosis liver section

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  Hemochromatosis acini

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  Hemochromatosis Liver

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  Hemosiderosis

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  Hemosiderin blood cells

Neonatal hemochromatosis Resources
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NIH genetic and rare disease info

• NIH info on Neonatal hemochromatosis

Neonatal hemochromatosis is a rare disease.