From the Research
Management of a patient with hyperferritinemia and iron deficiency requires addressing both conditions simultaneously while identifying the underlying cause, with a focus on treating iron deficiency with oral iron supplementation and investigating the cause of hyperferritinemia. The approach to managing hyperferritinemia and iron deficiency involves several key steps:
- Treating iron deficiency with oral iron supplementation, typically ferrous sulfate 325 mg daily or twice daily, taken on an empty stomach with vitamin C to enhance absorption, as supported by 1
- Investigating the cause of hyperferritinemia, which may be due to inflammation, liver disease, malignancy, or other conditions rather than iron overload, as highlighted in 2
- Laboratory evaluation should include complete blood count, liver function tests, inflammatory markers (CRP, ESA), and transferrin saturation, with a focus on assessing iron availability and identifying potential underlying causes, as discussed in 3
- If transferrin saturation is low despite high ferritin, this confirms iron deficiency with concurrent inflammatory state, and treatment should focus on addressing both conditions, as noted in 3
- Avoiding phlebotomy or iron chelation therapy unless there is evidence of true iron overload (high transferrin saturation), as cautioned against in 4
- Regular monitoring of hemoglobin, ferritin, and transferrin saturation every 4-8 weeks during treatment is essential to assess response to therapy and adjust treatment as needed, as recommended in 1
This approach is supported by the most recent and highest quality study, 3, which highlights the importance of considering the limitations of serum ferritin in diagnosing iron deficiency in inflammatory conditions and using transferrin saturation to assess iron availability. By following this approach, clinicians can effectively manage patients with hyperferritinemia and iron deficiency, addressing both conditions simultaneously and improving patient outcomes.