From the Guidelines
An elevated iron level of 200 μg/dL suggests possible iron overload, which requires further evaluation and management, and I recommend initiating therapeutic phlebotomy to reduce iron levels and prevent complications, as supported by the most recent guidelines 1. To confirm iron overload and determine its severity, additional tests including total iron binding capacity (TIBC), transferrin saturation, and ferritin levels should be performed.
- The goal of treatment is to reduce iron levels to a target serum ferritin of 50-100 lg/L, as recommended by the EASL clinical practice guidelines 1.
- Therapeutic phlebotomy involves removing 400-500 mL of blood every 1-2 weeks, with a target of reducing serum ferritin to <50 lg/L during the induction phase, and maintaining a level of 50-100 lg/L during the maintenance phase 1.
- It is essential to monitor serum haemoglobin and ferritin levels regularly to avoid overtreatment and iron deficiency, and to adjust the phlebotomy schedule as needed 1.
- For patients who cannot tolerate phlebotomy, iron chelation therapy with medications like deferasirox or deferoxamine may be necessary, although this is typically considered a secondary option 1.
- Dietary modifications, such as limiting iron-rich foods, vitamin C supplements, and alcohol, may also be recommended to help manage iron levels and prevent complications 1.
- Identifying the underlying cause of elevated iron, such as hereditary hemochromatosis, multiple blood transfusions, or liver disease, is crucial to guide treatment and prevent long-term complications 1.
From the Research
Elevated Iron Levels
Elevated iron levels, also known as iron overload, can be caused by various factors, including genetic disorders, blood transfusions, and certain medical conditions.
- Iron overload can lead to serious health problems, such as liver and heart damage, if left untreated 2.
- Serum ferritin concentration is often used as an index of iron deficiency and overload, with low ferritin indicating iron deficiency and elevated ferritin reflecting risk of iron overload 3.
- However, ferritin is also an acute-phase protein, and its levels can be elevated in inflammation and infection, making it a less reliable indicator in certain cases 3.
Treatment Options
Several treatment options are available for iron overload, including:
- Phlebotomy, which involves removing blood from the body to reduce iron levels 4.
- Iron chelation therapy, which uses medications such as deferasirox to bind to iron and remove it from the body 4, 5, 6.
- Combination therapy, which involves using multiple medications or treatments to reduce iron levels 5.
Diagnostic Testing
Diagnostic testing for iron overload typically involves measuring serum ferritin concentration and transferrin-iron saturation, as well as genetic testing for hereditary hemochromatosis 2.