From the Guidelines
Elevated ferritin with dizziness should be evaluated by a healthcare provider as it may indicate several possible conditions, including hemochromatosis, inflammation, liver disease, or certain cancers, and the patient should undergo comprehensive blood tests, including complete blood count, liver function tests, iron studies, and inflammatory markers, as recommended by the EASL clinical practice guidelines on haemochromatosis 1. The high ferritin (iron storage protein) could represent hemochromatosis (iron overload), inflammation, liver disease, or certain cancers, while dizziness might be related or a separate issue.
- Initial management includes:
- Comprehensive blood tests including complete blood count, liver function tests, iron studies (transferrin saturation), and inflammatory markers.
- Genetic testing for hemochromatosis mutations may be warranted if iron overload is suspected, as suggested by the American Association for the Study of Liver Diseases 1.
- Treatment depends on the underlying cause, such as:
- Therapeutic phlebotomy (blood removal) for hemochromatosis.
- Addressing inflammatory conditions if present.
- Treating other identified causes. The dizziness requires separate evaluation, including:
- Blood pressure assessment.
- Neurological examination.
- Possibly vestibular testing. The connection between elevated ferritin and dizziness isn't straightforward, but excessive iron can potentially cause neurological symptoms in advanced cases of iron overload, as noted in the EASL clinical practice guidelines on haemochromatosis 1. Staying hydrated and avoiding sudden position changes may help manage dizziness while awaiting medical evaluation. Regular monitoring of ferritin levels will be necessary if a chronic condition is identified, and the patient's inflammatory status should be clearly defined to aid in diagnosis, as recommended by the European evidence-based consensus on the diagnosis and management of ulcerative colitis 1.
From the Research
Elevated Ferritin and Dizziness
- Elevated ferritin levels can be caused by various conditions, including iron overload, acute phase reactions, and underlying diseases such as infections, solid tumors, liver dysfunction, renal failure, and hematological malignancies 2.
- Hyperferritinemia is a non-specific finding, and differentiation of the presence or absence of an associated iron overload is essential for proper diagnosis and management 3.
- Dizziness can be a symptom of iron overload, as excess iron can lead to tissue damage and oxidative stress, affecting various organs and systems in the body 4.
Iron Overload and Chelation Therapy
- Iron overload can be treated with phlebotomy, iron chelating therapy, or a combination of both, depending on the underlying cause and severity of the condition 4, 5.
- Iron chelating therapy can help lower tissue iron levels and prevent iron overload complications, improving event-free survival (EFS) 5.
- Chelation therapy provides a way of treating iron overload and minimizing its adverse effects, and nurses need to understand the implications of iron overload and chelation therapy in patient care 6.
Diagnostic Workup and Management
- Estimating serum ferritin levels is the easiest and most employed diagnostic tool for assessing body iron stores, although it may not be specific 5.
- An algorithm for the diagnostic workup and management of hyperferritinemia is proposed, including the evaluation of underlying conditions, iron overload, and the selection of appropriate treatment options 3.
- MRI can be used to monitor cardiac iron load and guide the selection of iron chelating therapy 4.