National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Hemochromatosis type 3



Other Names:
Hemochromatosis due to defect in transferrin receptor 2; HFE3; TFR2-related hereditary hemochromatosis
Categories:
This disease is grouped under:

Hemochromatosis type 3 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. While many organs can be affected, iron overload is especially likely to affect the liver, heart, and pancreas. Early symptoms of hemochromatosis type 3 can include fatigue, weakness, and joint pain. Other symptoms may include abdominal pain, loss of sex drive, liver disease, diabetes, heart problems, and skin discoloration.[1] Symptoms of hemochromatosis type 3 typically begin before 30-years-old.[2]

Hemochromatosis type 3 is caused by genetic changes (mutations or pathogenic variants) to the TFR2 gene.[2][3] The disease is inherited in an autosomal recessive manner. A diagnosis of hemochromatosis type 3 is suspected when a doctor observes signs and symptoms of the disease. A doctor may decide to order laboratory tests including a liver biopsy, MRI, or blood test. The diagnosis can be confirmed with genetic testing.[1] Treatment of hemochromatosis type 3 usually involves reducing iron levels by removing blood (phlebotomy) or iron chelation. These treatments can prevent additional organ damage but typically do not reverse existing damage.[1][4]

To learn more about other types of hemochromatosis click on the disease names below:
Last updated: 2/15/2018

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

Showing of 16 |
Medical Terms Other Names
Learn More:
HPO ID
Percent of people who have these symptoms is not available through HPO
Amenorrhea
Abnormal absence of menstruation
0000141
Anemia
Low number of red blood cells or hemoglobin
0001903
Arthritis
Joint inflammation
0001369
Autosomal recessive inheritance 0000007
Cardiomyopathy
Disease of the heart muscle
0001638
Cirrhosis
Scar tissue replaces healthy tissue in the liver
0001394
Elevated hepatic transaminase
High liver enzymes
0002910
Fatigue
Tired
Tiredness
[ more ]
0012378
Hyperpigmentation of the skin
Patchy darkened skin
0000953
Hypogonadotropic hypogonadism 0000044
Impotence
Difficulty getting a full erection
Difficulty getting an erection
[ more ]
0000802
Increased serum ferritin
Elevated serum ferritin
High ferritin level
Increased ferritin
Increased serum ferritin level
[ more ]
0003281
Increased serum iron 0003452
Lymphopenia
Decreased blood lymphocyte number
Low lymphocyte number
[ more ]
0001888
Neutropenia
Low blood neutrophil count
Low neutrophil count
[ more ]
0001875
Purpura
Red or purple spots on the skin
0000979
Showing of 16 |
Last updated: 7/1/2020

Hemochromatosis type 3 is caused by genetic changes (mutations or pathogenic variants) in the TFR2 gene. The TFR2 gene provides the body with instructions to make a protein that helps iron enter liver cells. Pathogenic variants in the TFR2 gene cause this protein to not be able to correctly tell the liver cells how much iron to absorb. This causes iron to accumulate in tissues and organs, which can result in organ damage.[2][5]
Last updated: 2/15/2018

Hemochromatosis type 3 is inherited in an autosomal recessive manner.[2] This means that people with hemochromatosis type 3 have a genetic change (mutation or pathogenic variant) in both copies of the TFR2 gene in each cell of the body. We inherit one copy of every gene from our mother and the other from our father. The parents of a person with hemochromatosis type 3 are each expected to have one changed copy of the TFR2 gene. People with one changed copy of a gene are known as carriers. Carriers typically do not have signs or symptoms of hemochromatosis type 3.

When two carriers of hemochromatosis type 3 have children, each child has a:
  • 25% chance to have hemochromatosis type 3
  • 50% chance to be a carrier like each parent
  • 25% chance to have two working copies of the TFR2 gene, meaning the child is unaffected and is not a carrier of hemochromatosis type 3
Hemochromatosis type 3 is a disease that shows reduced penetrance. This means that some people with pathogenic variants in the TFR2 gene never show symptoms of the disease. However, children or other family members who have pathogenic variants causing hemochromatosis may show symptoms of the disease.[1][2][6] 
Last updated: 2/15/2018

Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person’s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional.

Testing Resources

  • The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.

Treatment for hemochromatosis type 3 may include reducing iron levels by removing blood (phlebotomy), iron chelation therapy, dietary changes, and treatment for complications of the disease. The goal of treatment is to reduce the amount of iron in the body to normal levels, prevent or delay organ damage from excess iron, and maintain normal amounts of iron throughout the lifetime.[1]

Phlebotomy helps to remove excess iron from the body. Most people begin treatment with weekly therapeutic phlebotomy, although sometimes treatment is initially twice a week if iron levels are very elevated. Maintenance phlebotomy usually involves treatment every 2-4 months.[7] Iron chelation therapy may be recommended for some people with hemochromatosis type 3 if they have other health issues. This involves removing excess iron using medications.[7]

Dietary recommendations for people with hemochromatosis may include avoiding alcohol and red meat. People with hemochromatosis are not recommended to take iron or vitamin C supplements.[7]

For more detailed information regarding the treatment of hemochromatosis, please reference the Medscape article about hemochromatosis. You may need to register to view the article, but registration is free. 
Last updated: 2/15/2018

If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments.

If you can’t find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care.

You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists.

Healthcare Resources


Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease.

Conditions with similar signs and symptoms from Orphanet
Differential diagnosis includes: i) for hyperferritinemia: alcoholism, polymetabolic syndrome, inflammatory conditions; ii) for visceral iron overload: a) in younger patients: type 2 hemochromatosis (see this term) and post-transfusional iron overload in the case of hematological diseases such as thalassemia major, sickle cell disease, and rare anemias (see these terms) b) in older patients: Type 1 hemochromatosis and post-transfusional iron overload (especially myelodysplastic syndromes).
Visit the Orphanet disease page for more information.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

Organizations Providing General Support


Living with a genetic or rare disease can impact the daily lives of patients and families. These resources can help families navigate various aspects of living with a rare disease.

Financial Resources

  • Good Days provides help to patients with life-altering conditions. Assistance includes help with the cost of medications and travel.
  • Patient Access Network Foundation (PAN Foundation) has Assistance Programs for those with health insurance who reside in the United States. The disease fund status can change over time, so you may need to check back if funds are not currently available. 

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

In-Depth Information

  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine. 
  • Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Hemochromatosis type 3. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know.


  1. Hemochromatosis. National Heart, Lung, and Blood Institute (NHLBI). https://www.nhlbi.nih.gov/health-topics/hemochromatosis. Accessed 1/28/2018.
  2. Hereditary hemochromatosis. Genetics Home Reference (GHR). May 2015; https://ghr.nlm.nih.gov/condition/hereditary-hemochromatosis.
  3. Hamilton JPA. Hereditary Hemochromatosis. Merck Manual Professional Version. January 2017; http://www.merckmanuals.com/professional/hematology-and-oncology/iron-overload/hereditary-hemochromatosis.
  4. Gersten T. Hemochromatosis. MedlinePlus. March 16, 2016; https://www.nlm.nih.gov/medlineplus/ency/article/000327.htm.
  5. TFR2 gene. Genetics Home Reference. October 2006; https://ghr.nlm.nih.gov/gene/TFR2.
  6. Camaschella C and Roetto A. TFR2-Related Hereditary Hemochromatosis. GeneReviews. June 9, 2011; https://www.ncbi.nlm.nih.gov/books/NBK1349/.
  7. Duchini A, Sfeir HE, and Klachko DM. Hemochromatosis. Medscape. April 4, 2017; http://emedicine.medscape.com/article/177216-overview.