Role of liver biopsy in the diagnosis of hepatic iron overload in the era of genetic testing

Shirin Nash, Sharon Marconi, Krystyna Sikorska, Rizwan Naeem, Gerald Nash

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


We studied hepatic iron overload (HIOL) patterns in 32 patients who underwent liver biopsies and testing for HFE mutations (C282Y, H63D). Iron-stained biopsy specimens were examined for patterns of iron deposits: hereditary hemochromatosis (HH) pattern or non-HH pattern. Visual iron grade based on amount of cellular and lobular iron was evaluated. We found the HH pattern in 17 biopsy specimens (53%) and the non-HH pattern in 6 specimens (19%). HH with superimposed non-HH was noted in 9 cases (28%). In 25 patients with HFE mutations, HH alone and combined with non-HH patterns was noted in 22 specimens (88%). Visual iron grade correlated approximately with the hepatic iron index. Heavy HIOL was noted in C282Y homozygotes and 1 patient with cirrhosis without either HFE mutation. Mild steatohepatitis was found in 21 specimens (66%); it was associated with the non-HH pattern in 80% (12/15) and the HH pattern in 62% (16/26) of cases. Liver biopsy can identify pattern and grade of HIOL and associated pathology for diagnosis and management of patients with abnormal iron studies and elevated liver function test results. Genetic tests for HFE mutations and liver biopsies are complementary in the workup of these patients.

Original languageEnglish (US)
Pages (from-to)73-81
Number of pages9
JournalAmerican journal of clinical pathology
Issue number1
StatePublished - 2002
Externally publishedYes


  • HFE mutations
  • Iron overload
  • Liver biopsy
  • Steatohepatitis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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