Implications of a Serum Iron Level of 95 micromol/L
A serum iron level of 95 micromol/L indicates significant iron overload that requires prompt evaluation and management to prevent organ damage and associated morbidity and mortality.
Understanding Iron Overload
- A serum iron level of 95 micromol/L is substantially elevated compared to normal reference ranges, suggesting iron overload that may lead to tissue damage and organ dysfunction 1
- Normal liver iron content in healthy adults should be below 50 μmol/g, with levels above this threshold indicating iron overload 2
- Iron overload can lead to progressive damage to the liver, heart, pancreas, and other organs if left untreated 2
Diagnostic Approach
Comprehensive iron studies should be performed, with particular attention to:
- Serum ferritin, which shows strong correlation with liver iron content (rho = 0.52) and is the most discriminatory biomarker for iron overload 2
- Transferrin saturation, which helps distinguish between different causes of iron overload 1
- Complete blood count to assess for anemia or other hematologic abnormalities 1
Consider genetic testing for hereditary hemochromatosis, particularly HFE gene mutations (C282Y and H63D), which are common causes of iron overload 3
Quantitative MRI assessment of liver iron content should be performed as a non-invasive method to confirm iron overload and assess severity 2
Clinical Manifestations to Evaluate
- Liver function tests should be carefully assessed, as elevated liver enzymes (particularly ALT) are strongly associated with iron overload (10.1-fold increased risk) 4
- Evaluate for arthropathy, especially of the metacarpophalangeal joints, which is independently associated with elevated iron levels (3.6-fold increased risk) 4
- Screen for other manifestations of iron overload including:
- Cardiac dysfunction
- Diabetes or glucose intolerance
- Skin pigmentation changes
- Hypogonadism 2
Management Recommendations
- Therapeutic phlebotomy should be initiated promptly with a target ferritin level of 50-100 μg/L to prevent organ damage and improve long-term outcomes 2
- Phlebotomy should be performed weekly (removal of 500 mL blood) as tolerated, with monitoring of hematocrit/hemoglobin prior to each procedure 2
- Serum ferritin should be checked every 10-12 phlebotomies to monitor progress 2
- Once target ferritin levels are achieved, maintenance phlebotomy should be continued at intervals to keep ferritin between 50-100 μg/L 2
Important Considerations and Precautions
- Vitamin C supplements should be avoided as they can accelerate iron mobilization to potentially dangerous levels 2
- Raw shellfish should be avoided due to risk of Vibrio vulnificus infection in patients with iron overload 2
- In patients with advanced cirrhosis due to iron overload, liver transplantation may be necessary 2
- For patients with cardiac complications, more gradual iron removal may be necessary to prevent arrhythmias 2
Monitoring
- Regular monitoring of ferritin levels is essential to guide phlebotomy frequency and ensure maintenance of target levels 2
- Periodic assessment of organ function (liver, heart, pancreas) should be performed to evaluate for improvement or progression of iron-related damage 2
- In patients with very high initial iron levels, follow-up quantitative MRI may be useful to confirm adequate iron removal 2