From the Guidelines
Ferritin levels typically begin to decrease 3 months after ALT levels normalize, as indicated by the need to perform serum ferritin analysis after every 10-12 phlebotomies, which corresponds to approximately 3 months, as stated in the 2011 practice guideline by the American Association for the Study of Liver Diseases 1.
The decrease in ferritin levels is reflective of the depletion of iron stores, which occurs as a result of phlebotomy treatment in patients with hemochromatosis. According to the guideline, TS usually remains elevated until iron stores are depleted, whereas ferritin eventually begins to fall progressively with iron mobilization 1.
Key factors that influence the timeline for ferritin decrease include:
- The severity of iron overload
- The frequency and volume of phlebotomy
- Individual differences in iron metabolism and mobilization
- The presence of underlying liver disease or other conditions affecting iron regulation
In general, it can be confidently assumed that excess iron stores have been mobilized when the serum ferritin drops to between 50 and 100 lg/L, as stated in the guideline 1. Regular monitoring of both ALT and ferritin levels is essential to track progress and adjust treatment as needed.
It is also important to note that lifestyle modifications, such as reducing alcohol consumption and maintaining a healthy weight, may help support the normalization of ferritin levels, although the guideline does not specify dietary adjustments as necessary, as the amount of iron absorption that an individual can affect with a low-iron diet is small (2-4 mg/day) 1.
From the Research
Reduction in ALT and Ferritin Levels
- The provided studies do not directly address the question of how long after ALT comes down, Ferritin will also come down 2, 3, 4, 5, 6.
- However, it is known that elevated serum ferritin can be seen in various conditions, including acute and chronic liver disease, and that treatment of iron overload can lead to a decrease in serum ferritin levels 2, 4.
- A study on deferasirox in patients with iron overload secondary to hereditary hemochromatosis found that the median time to achieve serum ferritin reduction ≥50% compared to baseline was 7.53 months 4.
- Another study found that a serum ferritin level less than 1000 microg/L was predictive of absence of cirrhosis, suggesting that ferritin levels can be used as a marker for iron overload and liver damage 5.
Relationship Between ALT and Ferritin
- The studies do not provide a direct correlation between the reduction in ALT levels and the subsequent reduction in Ferritin levels 2, 3, 4, 5, 6.
- However, it is known that liver damage and iron overload can lead to elevated levels of both ALT and Ferritin, and that treatment of the underlying condition can lead to a decrease in both markers 2, 4, 6.