Medicine · Liver Disease (Cirrhosis, Hepatitis, Autoimmune, Wilson's, Hemochromatosis)

Hereditary haemochromatosis most commonly results from which mutation, and which HFE genotype accounts for the majority of cases in Northern European populations?

  • A C282Y/C282Y homozygous HFE mutation
  • B H63D/H63D homozygous HFE mutation
  • C C282Y/H63D compound heterozygous HFE mutation
  • D SLC40A1 (ferroportin) mutation
Correct answer: A. C282Y/C282Y homozygous HFE mutation

Explanation

HFE-related hereditary haemochromatosis (HH) type 1 accounts for >90% of cases in Northern European populations, with C282Y/C282Y homozygosity responsible for ~85% of clinically significant iron overload. The C282Y mutation (missense Cys282Tyr on chromosome 6p) disrupts HFE protein interaction with transferrin receptor, impairing hepcidin signalling, leading to unrestricted dietary iron absorption. H63D/H63D homozygosity rarely causes clinical iron overload. Compound heterozygotes (C282Y/H63D) cause mild-moderate iron loading. Ferroportin mutations (SLC40A1) cause a distinct type 4 haemochromatosis.

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

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