From the Guidelines
A ferritin level of 738 ng/mL is significantly elevated and requires immediate attention to prevent complications from iron overload, with therapeutic phlebotomy being the recommended treatment approach to reduce ferritin levels to <50 µg/L during the induction phase and <100 µg/L during the maintenance phase, as per the latest guidelines 1.
Key Considerations
- The patient's ferritin level is significantly elevated, indicating iron overload, which can lead to serious complications if left untreated, including cirrhosis, heart failure, diabetes, and joint pain.
- The latest guidelines from the European Association for the Study of the Liver (2022) recommend therapeutic phlebotomy as the primary treatment for iron overload, with target ferritin levels of <50 µg/L during the induction phase and <100 µg/L during the maintenance phase 1.
- Additional tests, including transferrin saturation, complete blood count, and liver function tests, may be necessary to determine the cause and extent of iron overload.
- Common causes of iron overload include hereditary hemochromatosis, alcoholic liver disease, hepatitis, and multiple blood transfusions.
- Limiting iron-rich foods, vitamin C supplements, and alcohol consumption may also be recommended to prevent further iron accumulation.
Treatment Approach
- Therapeutic phlebotomy sessions every 1-2 weeks until ferritin levels normalize, followed by maintenance phlebotomy 2-4 times per year, are typically recommended to reduce iron overload and prevent complications.
- The patient should be monitored for reaccumulation of iron and undergo maintenance phlebotomy as needed, with target ferritin levels of <100 µg/L 1.
- Early intervention and treatment can prevent complications and improve long-term health outcomes, making it essential to consult with a healthcare provider promptly for further evaluation and treatment.
From the Research
Ferritin Levels and Iron Overload
- A ferritin level of 738 is considered elevated, indicating potential iron overload 2, 3, 4, 5, 6.
- Elevated ferritin levels can be associated with various conditions, including hemochromatosis, thalassemia major, and transfusional iron overload 2, 3, 4, 5, 6.
Diagnostic Relevance
- Serum ferritin levels are often used as a diagnostic marker for iron overload, but their accuracy can be limited in certain cases 3.
- A study found that the correlation between ferritin iron concentration and individual liver iron concentration was poor in patients with hemochromatosis and beta-thalassemia major 3.
- Another study suggested that extreme hyperferritinemia (ferritin levels above 2000 μg/L) can be associated with a range of diagnoses, including hematological malignancy, severe infection, and hemophagocytic lymphohistiocytosis (HLH) 4.
Treatment Options
- Deferasirox, an oral iron chelator, has been shown to be effective in reducing iron burden in patients with hereditary hemochromatosis, myelodysplastic syndrome, and aplastic anemia 2, 5, 6.
- Phlebotomy is also a common treatment for iron overload, but it may not be suitable for all patients, particularly those with severe anemia or other comorbidities 2.
- A study found that deferasirox was well tolerated and effective in reducing serum ferritin and liver iron concentration in transfusional iron overload patients with myelodysplastic syndrome or aplastic anemia 6.