Are elevated ferritin levels, iron saturation of 36%, total iron-binding capacity of 270, and iron levels of 96 concerning for iron overload?

From the Guidelines

These lab results do not definitively indicate iron overload, but the elevated ferritin level warrants further evaluation to rule out iron overload and other potential causes of ferritin elevation. The provided values show an elevated ferritin level of 979.9, which raises some concern, but the other iron parameters are within or close to normal ranges. Iron saturation of 36% is at the upper end of normal (typically 20-45%) 1, total iron-binding capacity of 270 μg/dL is within normal range (250-450 μg/dL), and iron level of 96 μg/dL is also within normal limits (60-170 μg/dL). Some key points to consider:

• Ferritin can be elevated due to various conditions besides iron overload, including inflammation, infection, liver disease, or malignancy 1.
• To properly evaluate for true iron overload, additional testing would be recommended, such as genetic testing for hereditary hemochromatosis mutations (HFE gene) if there is a family history or clinical suspicion 1.
• Monitoring these values over time would also be valuable, as a persistent pattern of elevation would be more concerning than a single elevated reading.
• If symptoms of iron overload are present (fatigue, joint pain, abdominal pain, skin darkening), further evaluation by a hematologist would be appropriate 1. It's also important to note that serum iron parameters alone are often insufficient to ascertain iron overload, and non-invasive assessment of tissue iron overload by MRI can be helpful in diagnosis and management 1.

From the Research

Iron Overload Concerns

• The provided lab results show a ferritin level of 979.9, iron saturation of 36%, total iron-binding capacity (TIBC) of 270, and iron levels of 96.
• According to the study by the Hemochromatosis Management Working Group 2, therapeutic phlebotomy is recommended for men with serum ferritin levels of 300 microg/L or more and women with serum ferritin levels of 200 microg/L or more.
• The ferritin level of 979.9 is above the recommended threshold, suggesting potential iron overload.
• However, iron saturation of 36% is not excessively high, as iron overload is typically associated with saturation levels above 50% 3.

Comparison with Study Findings

• A study on the impact of pre-stem cell transplant ferritin level on late transplant complications found that elevated ferritin levels were associated with increased non-relapse mortality 4.
• Another study on body iron metabolism and pathophysiology of iron overload noted that serum ferritin is a convenient and widely available modality for estimating body iron, but its specificity can be problematic 3.
• A study on iron overload in hematopoietic cell transplantation found that elevated pretransplant ferritin levels increased the risk of nonrelapse mortality following transplantation 5.

Considerations for Iron Overload Diagnosis

• The diagnosis of iron overload should be based on a combination of clinical findings, laboratory results, and imaging studies 3, 5.
• The provided lab results suggest potential iron overload, but further evaluation and consideration of other factors, such as medical history and physical examination, are necessary to confirm the diagnosis.
• Iron chelation therapy or phlebotomy may be considered as treatment options for iron overload, depending on the severity of the condition and individual patient factors 2, 6.