From the Guidelines
For a patient with suspected high iron levels due to lab error, the management plan should begin with repeat testing to confirm the abnormal result before initiating any treatment. The first step is to order a repeat serum iron panel, including serum iron, total iron binding capacity (TIBC), transferrin saturation, and ferritin levels, as recommended by the American Association for the Study of Liver Diseases 1. The repeat test should be performed after an overnight fast to minimize dietary influences on iron levels. If the repeat test shows normal values, the initial high result was likely due to laboratory error, and no further action is needed. However, if elevated iron levels are confirmed, additional diagnostic workup is warranted, including genetic testing for hereditary hemochromatosis (HFE gene mutations), liver function tests, and possibly liver imaging. For confirmed iron overload, treatment typically involves therapeutic phlebotomy, removing one unit of blood (approximately 200-250 mg iron) weekly until ferritin levels normalize (usually below 50-100 ng/mL), as stated in the 2011 practice guideline by the American Association for the Study of Liver Diseases 1. Therapeutic phlebotomy should be performed once or twice per week as tolerated, with each phlebotomy preceded by measurement of the hematocrit or hemoglobin to avoid reducing the hematocrit/hemoglobin to <80% of the starting value 1. Laboratory errors in iron testing can occur due to hemolysis during blood collection, non-fasting status, recent iron supplementation, or technical issues with the assay, highlighting the importance of proper patient preparation and sample handling for accurate results 1. It is also important to note that dietary adjustments are unnecessary during treatment for iron overload, and vitamin C supplements and iron supplements should be avoided, as recommended by the American Association for the Study of Liver Diseases 1. Regular monitoring for reaccumulation of iron and maintenance phlebotomy are also crucial in managing patients with iron overload, with target ferritin levels of 50-100 lg/L 1.
From the FDA Drug Label
Deferoxamine mesylate for injection is indicated as an adjunct to standard measures for the treatment of acute iron intoxication. The dosage (based on body weight in mg/kg/day), rates of administration, and mode of administration for both adults and pediatric patients are individually determined and adapted during the course of therapy based on the severity of the patient’s iron overload
The management plan for a patient with suspected high iron levels due to lab error is not directly addressed in the drug label. However, if the high iron levels are confirmed to be due to acute iron intoxication, the treatment may involve:
- Deferoxamine mesylate for injection as an adjunct to standard measures
- Dosage: individually determined based on body weight and severity of iron overload
- Administration: intramuscularly or intravenously, depending on the patient's condition 2
Note: The label does not provide guidance on managing high iron levels due to lab error specifically.
From the Research
Management Plan for Suspected High Iron Levels due to Lab Error
- The first step is to verify the iron levels through repeat testing to rule out any lab error 3.
- If the high iron levels are confirmed, it is essential to determine the cause of the iron overload. However, in cases where lab error is suspected, the focus should be on verifying the results rather than treating the patient for iron overload.
- In general, for patients with confirmed iron overload, iron chelation therapy is a common treatment approach. Deferoxamine, deferasirox, and deferprione are some of the iron chelators used to remove excess iron from the body 4, 5, 6, 7.
- The choice of iron chelator and the treatment plan depend on various factors, including the severity of iron overload, the patient's overall health, and the presence of any underlying conditions.
- It is crucial to monitor the patient's iron levels and adjust the treatment plan as needed to prevent organ damage and other complications associated with iron overload 5, 7.
- In cases where lab error is suspected, it is essential to investigate the cause of the error and take corrective action to prevent similar errors in the future 3.