From the Research
Phlebotomy is generally not indicated for patients with non-alcoholic steatohepatitis (NASH) and hyperferritinemia, as the elevated ferritin levels typically reflect inflammatory processes rather than true iron overload, making phlebotomy ineffective as a primary treatment. The evidence from recent studies, such as 1, suggests that hyperferritinemia in NASH is often due to inflammation without hepatic iron overload, and phlebotomy is only effective in cases with hepatocellular iron overload.
Key Considerations
- Hyperferritinemia in NASH is often a marker of disease severity rather than a therapeutic target 2
- Patients should undergo proper evaluation to exclude hereditary hemochromatosis or other causes of iron overload before considering any iron-reduction therapies 3
- The cornerstone of NASH treatment remains addressing metabolic syndrome components and improving insulin sensitivity through lifestyle changes, including weight loss, regular exercise, and a healthy diet 1
Management Approach
- Lifestyle modifications, such as weight loss of 7-10% of body weight, regular exercise (150 minutes weekly of moderate activity), and a healthy diet low in processed foods and added sugars, should be the primary focus of treatment
- Phlebotomy may be considered in selected cases with confirmed hepatic iron overload, but the evidence for routine use remains insufficient 4
- A thorough evaluation, including genetic testing and imaging studies, should be performed to determine the underlying cause of hyperferritinemia and to guide treatment decisions 5