Screening for hemochromatosis and iron deficiency in employees and primary care patients in Western Germany

Ann Intern Med. 1998 Mar 1;128(5):337-45. doi: 10.7326/0003-4819-128-5-199803010-00001.


Background: Many physicians still believe that iron overload (hemochromatosis) is an uncommon disorder.

Objective: To estimate the frequency of iron overload and iron deficiency in a group of employees and a group of outpatients.

Design: Prospective screening study.

Setting: Western Germany.

Participants: 3012 asymptomatic employees and 3027 outpatients of nine practitioners.

Measurements: Serum ferritin levels and transferrin saturation were measured. Participants with repeatedly abnormal results had thorough clinical evaluations to identify the cause of iron deficiency or overload.

Results: Gross iron overload (elevated transferrin saturation and ferritin levels) was proven by liver biopsy and phlebotomy treatment in 28 participants (0.4% of female outpatients, 0.7% of male outpatients, 0.2% of female employees, and 0.4% of male employees) and in six siblings of these participants. Of the 34 participants with iron overload, 30 were precirrhotic. Because 60% of an unselected group of employees with elevated transferrin saturation but normal ferritin levels were assumed to have early hemochromatosis, the prevalence of hemochromatosis was estimated to be 1.8% among patients (1.9% in women and 1.6% in men) and 1.0% among employees (1.1% in women and 1.0% in men). Iron deficiency was found in 6.8% of female patients, 2.4% of male patients, 6.0% of female employees, and 0.5% of male employees.

Conclusions: Iron deficiency was more common in women, and iron overload was more common in men. Among male employees, iron overload was almost as common as iron deficiency.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Anemia, Iron-Deficiency / diagnosis
  • Anemia, Iron-Deficiency / epidemiology*
  • Anemia, Iron-Deficiency / etiology
  • Employment
  • Female
  • Ferritins / blood
  • Germany / epidemiology
  • Hemochromatosis / diagnosis
  • Hemochromatosis / epidemiology*
  • Hemochromatosis / etiology
  • Humans
  • Industry
  • Male
  • Mass Screening*
  • Middle Aged
  • Prevalence
  • Primary Health Care
  • Prospective Studies
  • Regression Analysis
  • Sex Factors
  • Transferrin / analysis


  • Transferrin
  • Ferritins