From the Guidelines
Elevated ferritin and hematocrit in a prediabetic female with dizziness and mild headache is concerning and warrants further investigation for potential iron overload or hemochromatosis.
Key Considerations
- Elevated serum ferritin can be indicative of iron overload, but it can also be elevated in inflammatory conditions, liver disease, and other non-hepatic chronic inflammatory conditions 1.
- A serum ferritin level >200 lg/L in women is considered elevated and may indicate iron overload, but it is essential to rule out other causes of hyperferritinemia, such as chronic alcohol consumption, inflammation, cell necrosis, tumors, and non-alcoholic fatty liver disease (NAFLD) 1.
- Hematocrit levels are not directly addressed in the provided evidence, but it is essential to consider that elevated hematocrit can be a sign of dehydration, polycythemia, or other conditions.
Diagnostic Approach
- The initial approach to diagnosis should include indirect markers of iron stores, such as transferrin saturation (TS) and serum ferritin 1.
- If TS is elevated, it is essential to confirm the result with a second determination, and it is advisable to do this on a fasting specimen 1.
- Genetic testing for HFE mutations, such as C282Y and H63D, should be considered in patients with otherwise unexplained increased serum ferritin and increased transferrin saturation 1.
Clinical Implications
- Patients with symptoms or signs suggestive of hemochromatosis, such as unexplained liver disease, chondrocalcinosis, type 1 diabetes, arthralgia, or cardiomyopathy, should undergo diagnostic work-up, including serum iron parameters and genetic testing 1.
- In patients with elevated serum ferritin and increased transferrin saturation, liver biopsy may be necessary to diagnose hemochromatosis, especially if serum ferritin is above 1000 lg/L or if there are signs of liver disease 1.
From the Research
Elevated Ferritin and Hematocrit in a Prediabetic Female
Elevated ferritin and hematocrit levels in a prediabetic female with dizziness and mild headache can be concerning and may indicate an underlying condition.
- The causes of elevated ferritin levels can be varied, including inflammation, infection, chronic iron overload, or other uncommon pathologies such as hemophagocytic lymphohistiocytosis (HLH) 2.
- A study found that the most frequent conditions associated with elevated ferritin levels were malignancy and iron-overload syndromes, with rheumatologic diseases being less common 3.
- Elevated serum ferritin concentrations can also be related to noniron overload conditions, such as metabolic syndrome, obesity, diabetes, liver disease, malignancy, infection, or inflammation 4.
Association with Pre-diabetes
- Research has shown that high ferritin and low transferrin saturation are associated with pre-diabetes among a national representative sample of U.S. adults 5.
- This association suggests that iron metabolism may play a role in the development of pre-diabetes, although the underlying mechanism is not fully understood.
- The study found that higher ferritin and lower transferrin saturation were associated with a higher risk of pre-diabetes, even after adjusting for sociodemographics, physical activity, and metabolic and inflammatory markers 5.
Clinical Considerations
- In evaluating a patient with elevated serum ferritin, it is essential to consider various factors, including the patient's history, transferrin saturation, serum concentrations of alanine and aspartate aminotransferases, testing for HFE mutations, liver imaging, and liver biopsy 6.
- Referral to a specialist, such as a gastroenterologist, hematologist, or physician with an interest in iron overload, may be necessary if the cause of elevated serum ferritin is unclear or if serum ferritin is >1000 µg/L 4.