From the Guidelines
High ferritin levels with low iron typically indicate inflammation rather than iron overload, and the underlying cause of inflammation should be identified and treated. When the body experiences inflammation from conditions like infections, autoimmune disorders, liver disease, or chronic diseases, ferritin increases as an acute phase reactant while iron becomes less available in the bloodstream 1. This pattern can be seen in anemia of chronic disease, where iron becomes trapped in storage sites and unavailable for red blood cell production. Some key points to consider in this condition include:
- Laboratory tests like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) can help confirm if inflammation is present 1.
- A complete iron panel including transferrin saturation and total iron binding capacity provides a more comprehensive picture of iron status.
- Medical evaluation is essential as this pattern can indicate serious conditions requiring specific treatment approaches beyond simple iron supplementation.
- According to the most recent guidelines, patients with haemochromatosis are more commonly affected by liver disease, including liver tumours, rheumatoid arthritis, osteoarthritis, osteoporosis, chondrocalcinosis, and diabetes mellitus 1.
- The first step in testing for haemochromatosis is the assessment of serum iron parameters, which should include transferrin saturation and serum ferritin 1. Treatment should focus on addressing the underlying cause of inflammation, and iron supplementation should be avoided if not necessary, as it could be harmful. In cases of haemochromatosis, phlebotomy is the mainstay of treatment, with targets of ferritin <50 µg/L during the induction phase and <100 µg/L during the maintenance phase 1.
From the Research
Iron Overload with High Ferritin and Low Iron
- Iron overload can occur even with low iron levels, and high ferritin levels are often an indicator of this condition 2.
- Ferritin is a protein that stores iron in the body, and elevated levels can indicate iron overload, even if iron levels are low 2, 3.
- Hereditary hemochromatosis is a genetic disorder that can cause iron overload, and it is often diagnosed through laboratory testing for serum ferritin and transferrin saturation 3.
Diagnosis and Treatment
- The diagnosis of hemochromatosis typically involves measuring serum transferrin saturation and serum ferritin levels, as well as liver biopsy to assess iron stores and detect cirrhosis 2.
- Treatment for hereditary hemochromatosis usually involves phlebotomy to remove excess iron stores, and this can be an effective way to manage the condition 4, 3.
- In some cases, alternative treatments such as deferasirox may be used, especially for patients who are intolerant of phlebotomy or have refractory iron overload 5.
Management and Prognosis
- Early diagnosis and treatment of hemochromatosis are crucial to prevent serious chronic disease and improve life expectancy 2.
- Regular monitoring of serum ferritin levels and transferrin saturation is necessary to manage the condition and prevent iron overload 4, 3.
- Patient compliance with phlebotomy therapy is important for achieving and maintaining iron depletion, and regular follow-up is necessary to ensure ongoing management of the condition 4.