From the Guidelines
Working up high ferritin levels is crucial to identify and manage underlying conditions that can significantly impact morbidity, mortality, and quality of life, particularly in cases of iron overload disorders like hemochromatosis, where early intervention can prevent complications such as liver cirrhosis, heart problems, and diabetes. The initial approach to a patient with high ferritin levels should include a thorough history and physical examination to identify any symptoms or signs suggestive of iron overload or other conditions that could cause elevated ferritin, such as inflammatory diseases, liver disease, or cancer 1.
Key laboratory tests to determine the cause of elevated ferritin include serum iron studies (iron, total iron binding capacity, transferrin saturation), liver function tests, complete blood count, inflammatory markers like C-reactive protein, and hemoglobin A1C to check for diabetes. If iron overload is suspected, genetic testing for hereditary hemochromatosis (HFE gene mutations) should be considered, as it is a common cause of elevated ferritin and can lead to significant morbidity if left untreated 1.
For patients with significantly elevated ferritin and high transferrin saturation, liver biopsy may be necessary to assess hepatic iron concentration and potential liver damage, as the degree of iron overload can correlate with the risk of developing complications such as cirrhosis and hepatocellular carcinoma. Common causes of elevated ferritin include iron overload disorders (hemochromatosis), inflammatory conditions, liver disease, alcohol use disorder, metabolic syndrome, and certain cancers.
Early identification and treatment of the underlying cause can prevent complications and improve quality of life. In cases of hemochromatosis, regular phlebotomy may be needed to reduce iron levels, and the frequency of maintenance phlebotomy can vary among individuals due to the variable rate of iron accumulation 1. It is also important to avoid supplemental vitamin C in iron-loaded patients undergoing phlebotomy, as it can accelerate iron mobilization and increase the risk of sudden death due to cardiac arrhythmias or cardiomyopathy.
In summary, a comprehensive workup for high ferritin levels is essential to diagnose and manage underlying conditions effectively, with a focus on preventing complications and improving patient outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Deferasirox tablets therapy should only be considered when a patient has evidence of chronic transfusional iron overload. The evidence should include the transfusion of at least 100 mL/kg of packed red blood cells (e.g., at least 20 units of packed red blood cells for a 40 kg person or more in individuals weighing more than 40 kg), and a serum ferritin consistently greater than 1000 mcg/L Monitor serum ferritin monthly and adjust the dose of deferasirox tablets, if necessary, every 3 to 6 months based on serum ferritin trends Use the minimum effective dose to achieve a trend of decreasing ferritin Adjust dose based on serum ferritin levels o If the serum ferritin falls below 1000 mcg/L at 2 consecutive visits, consider dose reduction, especially if the deferasirox tablets dose is greater than 17.5 mg/kg/day o If the serum ferritin falls below 500 mcg/L, interrupt deferasirox tablets therapy and continue monthly monitoring.
High ferritin levels indicate iron overload, which can lead to serious health problems.
- Monitoring ferritin levels is essential to assess the effectiveness of deferasirox therapy and adjust the dose as needed.
- Adjusting the dose based on serum ferritin levels helps prevent overchelation and ensures the minimum effective dose is used to maintain a low-iron burden.
- Regular monitoring of serum ferritin levels, blood counts, liver function, and renal function is crucial to minimize the risk of adverse events associated with deferasirox therapy 2.
From the Research
Reasons to Investigate High Ferritin Levels
- High ferritin levels can be an indicator of iron overload, which can lead to various health problems 3, 4
- However, hyperferritinemia is often a non-specific finding and can be caused by various factors such as acute phase reactions, inflammation, and underlying medical conditions 3, 5
- It is essential to differentiate between iron overload and other causes of hyperferritinemia to provide appropriate management and treatment 3, 5
Diagnostic Approach
- The diagnostic approach to hyperferritinemia involves a three-stage process, starting with clinical findings and simple laboratory tests to identify common causes such as alcoholism, inflammatory syndrome, and metabolic syndrome 5
- If transferrin saturation is high, hereditary hemochromatosis should be considered, and further testing such as hepatic MRI may be necessary to assess iron concentration 5
- In some cases, multiple causes of hyperferritinemia may be present simultaneously, making diagnosis and treatment more complex 5
Treatment and Management
- The treatment of hyperferritinemia depends on the underlying cause and may involve iron reduction therapy in cases of true iron overload 6
- However, the decision to treat should be individualized, and the presence of other features of iron overload should be taken into account 6
- In cases where iron overload is not present, treatment should focus on addressing the underlying cause of hyperferritinemia, such as inflammation or metabolic syndrome 3, 5