A 62-year-old man with hereditary haemochromatosis (HFE C282Y homozygous) has been on regular phlebotomy therapy. His target ferritin has now been reached (<50 μg/L). He asks about alcohol use. He drinks 3 units/day. Apart from continued monitoring, which complication is he MOST at risk for in the long term if he drinks alcohol?

• A Secondary haemochromatosis from alcohol-induced iron absorption
• B Pancreatic calcification
• C Hepatocellular carcinoma, risk markedly amplified by alcohol ✓
• D Hypogonadism refractory to phlebotomy

Explanation

Even after iron depletion by phlebotomy, established cirrhosis in haemochromatosis carries a 200-fold increased risk of HCC. Alcohol acts synergistically with iron overload to promote hepatic fibrosis, oxidative stress, and carcinogenesis — alcohol consumption markedly amplifies HCC risk and reduces the benefit of phlebotomy in patients with cirrhosis. Patients should be strongly counselled to abstain. While hypogonadism from pituitary iron deposition may persist, it is not worsened by ongoing alcohol to the same degree.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.