PT - JOURNAL ARTICLE AU - Ooka, Kohtaro AU - Onyiuke, Ifeyinwa AU - Zhang, Xuchen AU - Taddei, Tamar Hamosh TI - Protective altruistic phlebotomy: hereditary haemochromatosis presenting as hepatocellular carcinoma in a non-cirrhotic 83-year-old man AID - 10.1136/bcr-2016-216649 DP - 2016 Sep 02 TA - BMJ Case Reports PG - bcr2016216649 VI - 2016 4099 - http://casereports.bmj.com/content/2016/bcr-2016-216649.short 4100 - http://casereports.bmj.com/content/2016/bcr-2016-216649.full AB - Hereditary haemochromatosis is a multisystem disorder of iron metabolism. Hepatic manifestations include hepatomegaly, cirrhosis and hepatocellular carcinoma. Hepatocellular carcinoma is almost always preceded by cirrhosis. We present a case of an 83-year-old man without history of liver disease or iron overload who presented with abdominal pain. Workup revealed mildly elevated transaminases, ferritin of 3996 and a solitary liver tumour. Biopsy was consistent with hepatocellular carcinoma in a background of haemosiderosis without cirrhosis. He was diagnosed with hereditary haemochromatosis and hepatocellular carcinoma. He underwent a partial hepatectomy and was started on routine phlebotomy and surveillance imaging. He has improved and has not had signs of recurrence or new complications of haemochromatosis. We suggest a possible reason for his unique and late presentation.