From the Guidelines
Elevated ferritin levels in males are a significant indicator of potential iron overload, which can lead to severe health complications, including liver damage, heart problems, and diabetes, and thus, prompt medical evaluation and management are crucial. The implications of elevated ferritin levels in males can be understood through the lens of haemochromatosis, an autosomal recessive condition characterized by elevated transferrin saturation (TSAT) and progressive iron loading that mainly affects the liver 1. According to the EASL clinical practice guidelines on haemochromatosis, provisional iron overload based on serum iron parameters, including ferritin >300 µg/L in males, is sufficient to diagnose haemochromatosis in patients homozygous for p.Cys282Tyr in HFE 1.
Key Considerations
- Elevated ferritin levels can result from hereditary hemochromatosis, alcoholic liver disease, inflammation, metabolic syndrome, or certain cancers.
- Early diagnosis and treatment by phlebotomy can prevent cirrhosis, hepatocellular carcinoma, diabetes, arthropathy, and other complications.
- Treatment targets for phlebotomy are ferritin <50 µg/L during the induction phase and <100 µg/L during the maintenance phase 1.
- Dietary modifications, including limiting alcohol, vitamin C supplements with meals, red meat, and iron-fortified foods, are recommended.
- Chelation therapy with medications like deferasirox (Exjade) may be prescribed in severe cases or when phlebotomy isn't tolerated.
Management Approach
For confirmed cases of hemochromatosis or iron overload, therapeutic phlebotomy (blood removal) every 1-2 weeks until ferritin levels normalize (below 50-100 ng/mL), followed by maintenance phlebotomy 2-4 times yearly, is often the recommended treatment approach 1. It's essential to monitor serum ferritin levels after every 10-12 phlebotomies (approximately 3 months) in the initial stages of treatment and adjust the frequency of maintenance phlebotomy based on individual needs 1.
Importance of Early Treatment
Early treatment is crucial as untreated iron overload can damage the liver, heart, pancreas, and other organs, potentially leading to cirrhosis, diabetes, or heart failure. The decision to treat haemochromatosis with phlebotomy is straightforward and easy to justify for patients with evidence of liver disease or other end-organ manifestations 1. In cases where patients are asymptomatic and have normal liver tests, treatment is often initiated due to its safety, ease, and potential societal benefit (blood donation) 1.
From the Research
Implications of Elevated Ferritin Levels in Males
Elevated ferritin levels in males can have various implications, including:
- Iron overload disorders, such as hemochromatosis 2, 3
- Non-alcoholic fatty liver disease (NAFLD) 2
- Inflammatory conditions, such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome 3
- Malignancy 3
- Insulin resistance syndrome 2
- Hyperferritinemia due to other conditions, such as anemia of chronic inflammation or hyperlipemia type IIb 2, 3
Diagnostic Approaches
To determine the cause of elevated ferritin levels, various diagnostic approaches can be used, including:
- Serum ferritin and transferrin saturation measurements 2, 4
- Liver ultrasonography or magnetic resonance imaging (MRI) to assess liver iron concentration 2, 4
- Liver biopsy in selected patients with hereditary hemochromatosis 4
- Assessment of biochemical parameters, such as body mass index (BMI), γ-glutamyltransferase (GGT), and cholesterol levels 5, 6
Clinical Significance
Elevated ferritin levels can have significant clinical implications, including:
- Increased risk of iron overload and related complications, such as liver damage and cardiovascular disease 2, 3
- Need for further evaluation and monitoring to determine the underlying cause of hyperferritinemia 2, 3, 5, 6
- Potential for phlebotomy or other treatments to reduce iron levels and alleviate symptoms 2