From the Guidelines
If you have elevated ferritin levels, therapeutic phlebotomy is the recommended treatment, with a target ferritin level of 50-100 lg/L, as stated in the most recent guidelines 1. To determine the best course of action, it's essential to consult with a healthcare provider to identify the underlying cause of elevated ferritin levels. Some key points to consider:
- Therapeutic phlebotomy is typically performed weekly until ferritin drops below 50-100 lg/L, then maintenance sessions occur 2-4 times yearly 1.
- The volume and frequency of phlebotomies required to reach these goals are usually 400–500 ml weekly or every 2 weeks during the induction phase, depending on body weight and patient tolerance, and every 1–4 months during the maintenance phase, depending on the patient’s iron status 1.
- Serum haemoglobin should always be monitored during both induction and maintenance phases, at the time of each bloodletting session, to avoid overtreatment and iron deficiency 1.
- Regular monitoring of ferritin levels is crucial to track progress and adjust treatment, with measurements taken every month during the induction phase and every 6 months during the maintenance phase 1.
- Dietary modifications, such as reducing red meat, alcohol, and iron-fortified foods, may also be recommended, although the evidence for their effectiveness is limited 1.
- Chelation therapy with medications like deferasirox or deferoxamine may be prescribed in severe cases or when phlebotomy isn't suitable, but this is typically reserved for patients with significant iron overload or those who cannot undergo phlebotomy 1. It's essential to note that elevated ferritin levels can indicate excess iron storage or inflammation in the body, which, if left untreated, can damage organs like the liver, heart, and pancreas, potentially leading to serious complications, including cirrhosis, heart failure, and diabetes 1.
From the FDA Drug Label
Monitor serum ferritin monthly to evaluate for overchelation. Use the minimum dose to establish and maintain a low iron burden
The answer to managing elevated ferritin is to monitor serum ferritin monthly and use the minimum dose of deferasirox to establish and maintain a low iron burden. Key considerations include:
- Monitoring: Regular monitoring of serum ferritin levels to assess the effectiveness of treatment and prevent overchelation.
- Dose adjustment: Adjusting the dose of deferasirox as needed to maintain a low iron burden and prevent elevated ferritin levels 2.
From the Research
Elevated Ferritin: Causes and Management
Elevated ferritin levels can be caused by various conditions, including:
- Hereditary haemochromatosis, a genetic disorder that leads to systemic iron deposition and end-organ failure if left untreated 3
- Acute and chronic liver disease, systemic inflammatory states, and primary and secondary iron overload syndromes 3, 4
- Chronic liver disease, malignancy, infections, kidney failure, and rheumatic conditions, such as adult-onset Still's disease or hemophagocytic lymphohistiocytosis 5
- Hematologic disorders, iatrogenic causes, or chronic liver diseases 5
Diagnostic Approach
To diagnose the cause of elevated ferritin levels, the following steps can be taken:
- Confirmatory homeostatic iron regulator (HFE) genetic testing for C282Y and H63D mutations, which are commonly encountered in hereditary hemochromatosis 5
- Magnetic resonance imaging with quantitative assessment of iron content or liver biopsy, especially if liver disease is suspected 5
- Evaluation for secondary causes of iron overload, such as hematologic disorders, iatrogenic causes, or chronic liver diseases 5
Treatment Options
Treatment options for elevated ferritin levels depend on the underlying cause:
- Phlebotomy, which is commonly used to remove excess iron stores in patients with hereditary hemochromatosis 3, 6
- Individualized treatment, which may be influenced by the presence of other features of iron overload 7
- Iron reduction therapy, which may be beneficial in some cases, but the decision to treat should be individualized 7