From the Guidelines
Elevated ferritin levels should be treated with therapeutic phlebotomy, as it is a safe and effective method to reduce iron stores and prevent complications, as recommended by the most recent guidelines 1. The primary goal of treatment is to reduce iron stores to normal levels, which can be achieved through regular phlebotomy sessions. According to the 2022 EASL clinical practice guidelines on haemochromatosis 1, MRI can be helpful in detecting and quantifying iron overload, but it is not always necessary for diagnosis. Some key points to consider when treating elevated ferritin levels include:
- Therapeutic phlebotomy is the mainstay of treatment for hereditary hemochromatosis, with initial sessions weekly until levels normalize, then maintenance sessions 2-4 times yearly 1.
- Dietary modifications, such as limiting alcohol and vitamin C supplements, and reducing consumption of red meat and iron-fortified foods, can also be beneficial.
- Regular monitoring of ferritin levels is necessary to ensure treatment effectiveness and prevent complications, such as liver damage, heart problems, diabetes, and joint pain.
- The frequency of maintenance phlebotomy varies among individuals, due to the variable rate of iron accumulation in hemochromatosis, and should be determined on a case-by-case basis 1.
- It is essential to treat the underlying condition, such as liver disease, inflammation, or certain cancers, in cases of secondary iron overload.
- Serum iron parameters, including transferrin saturation and ferritin, should be monitored regularly to assess treatment effectiveness and adjust the phlebotomy schedule as needed 1.
From the Research
Elevated Ferritin: Causes and Investigation
- Elevated ferritin levels can be caused by various conditions, including iron overload, inflammation, infection, and malignancy 2
- Patient history, clinical features, and biochemical tests can help determine the cause of hyperferritinemia 2
- High transferrin saturation indicates iron overload, which is usually linked to hereditary hemochromatosis 2
Investigation and Diagnosis
- An algorithm for the investigation of hyperferritinemia can facilitate the investigation in both primary and inpatient care 2
- Serum glycosylated ferritin may be a potential marker for transfusion-related iron overload, with an optimal cutoff value of >587.55 ng/mL 3
- Liver biopsy is the gold standard for detecting iron overload, but non-invasive techniques such as estimating serum ferritin and using MRI for iron determination can also be used 4
Clinical Significance and Treatment
- Hyperferritinemia can be caused by various conditions, including non-human immunodeficiency virus infection, solid tumor, liver dysfunction, renal failure, and hematological malignancy 5
- Iron chelation therapy is necessary to prevent the consequences of hemosiderosis, and three chelators (deferoxamine, deferiprone, and deferasirox) are available for treatment 4, 6
- Adherence to therapy is crucial for good results, and alternating chelators can reduce adverse effects and improve compliance 6