美国预防服务工作组、欧洲肝脏研究联合会,以及美国家庭医生学会不支持在无症状的普通人群中进行常规检查。[4]European Association For The Study Of The Liver. EASL clinical practice guidelines for HFE hemochromatosis. J Hepatol. 2010;53:3-22.http://www.journal-of-hepatology.eu/article/S0168-8278(10)00197-2/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/20471131?tool=bestpractice.com[48]U.S. Preventive Services Task Force. Screening for hemochromatosis: recommendation statement. Ann Intern Med. 2006;145:204-208.http://annals.org/article.aspx?articleid=726788http://www.ncbi.nlm.nih.gov/pubmed/16880462?tool=bestpractice.com[49]American Academy of Family Physicians (AAFP). Summary of recommendations for clinical preventive services. June 2016. http://www.aafp.org/ (last accessed 11 July 2016).http://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/cps-recommendations.pdf即便在普通人群中血色病相关基因突变并不少见,但只有很少一部分基因突变患者会出现症状,发展为晚期疾病的患者更少。[21]Griffiths WJ. Review article: the genetic basis of haemochromatosis. Aliment Pharmacol Ther. 2007;26:331-342.http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2007.03387.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17635368?tool=bestpractice.com[23]Allen KJ, Gurrin LC, Constantine CC, et al. Iron-overload-related disease in HFE hereditary hemochromatosis. N Engl J Med. 2008;358:221-230.http://www.nejm.org/doi/full/10.1056/NEJMoa073286#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/18199861?tool=bestpractice.com[50]Olynyk JK, Hagan SE, Cullen DJ, et al. Evolution of untreated hereditary hemochromatosis in the Busselton population: a 17-year study. Mayo Clin Proc. 2004;79:309-313.http://www.ncbi.nlm.nih.gov/pubmed/15008603?tool=bestpractice.com[51]Andersen RV, Tybjaerg-Hansen A, Appleyard M, et al. Hemochromatosis mutations in the general population: iron overload progression rate. Blood. 2004;103:2914-2919.http://www.bloodjournal.org/content/103/8/2914.fullhttp://www.ncbi.nlm.nih.gov/pubmed/15070663?tool=bestpractice.com
血色病患者亲属的筛查尚存争议,但欧洲肝脏病研究联合会支持这一做法。[4]European Association For The Study Of The Liver. EASL clinical practice guidelines for HFE hemochromatosis. J Hepatol. 2010;53:3-22.http://www.journal-of-hepatology.eu/article/S0168-8278(10)00197-2/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/20471131?tool=bestpractice.com临床医生应考虑筛查成年家庭成员的空腹转铁蛋白饱和度和铁蛋白水平。如果发现这些指标升高,则应进一步检查,确认 HFE 基因突变。[52]Bryant J, Cooper K, Picot J, et al. A systematic review of the clinical validity and clinical utility of DNA testing for hereditary haemochromatosis type 1 in at-risk populations. Med Genet. 2008;45:513-518.http://www.ncbi.nlm.nih.gov/pubmed/18310265?tool=bestpractice.com[53]Bryant J, Cooper K, Picot J, et al. Diagnostic strategies using DNA testing for hereditary haemochromatosis in at-risk populations: a systematic review and economic evaluation. Health Technol Assess. 2009;13:iii, ix-xi, 1-126.http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0009/64692/FullReport-hta13230.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/19406046?tool=bestpractice.com兄弟姐妹患血色病的机率为25%。