From the Guidelines
Elevated ferritin levels should be treated with therapeutic phlebotomy, as it is a safe and effective method to reduce iron stores and prevent organ damage, as recommended by the 2022 EASL clinical practice guidelines on haemochromatosis 1.
Diagnosis and Treatment
Elevated ferritin levels indicate excess iron storage in the body and require medical evaluation to determine the underlying cause. If your ferritin is high, consult a healthcare provider who will likely order additional tests including complete blood count, liver function tests, and possibly genetic testing for hereditary hemochromatosis.
Phlebotomy Treatment
Treatment depends on the cause but may include therapeutic phlebotomy (blood removal) for conditions like hemochromatosis, with initial sessions weekly until levels normalize, then maintenance sessions 2-4 times yearly, as outlined in the 2011 practice guideline by the American Association for the Study of Liver Diseases 1.
Monitoring and Maintenance
Regular monitoring of ferritin levels is important to assess treatment effectiveness and prevent complications. MRI can be used to non-invasively quantify iron overload and guide diagnosis and management, especially in patients with suspected aceruloplasminemia or those who are homozygous for the p.C282Y variant of the HFE gene 1.
Key Considerations
- Elevated ferritin can damage organs including the liver, heart, and pancreas if left untreated, as excess iron generates harmful free radicals.
- Dietary modifications include limiting iron-rich foods and avoiding alcohol.
- For secondary causes, treating the underlying condition (like alcoholic liver disease, inflammation, or certain anemias) is essential.
- Serum iron parameters alone are often insufficient to ascertain iron overload, and tissue iron concentrations can be assessed non-invasively by MRI 1.
From the FDA Drug Label
For the treatment of transfusional iron overload in patients with chronic anemia. (1.2) In patients with serum ferritin level below 2,000 ng/mL require about 25 mg/kg/day. Patients with serum ferritin level between 2,000 and 3,000 ng/mL require about 35 mg/kg/day. Patients with higher serum ferritin may require up to 55 mg/kg/day
The drug deferoxamine is used to treat transfusional iron overload in patients with chronic anemia, which can cause elevated ferritin levels.
- The dosage of deferoxamine varies based on the patient's serum ferritin level.
- Patients with elevated ferritin levels may require higher doses of deferoxamine, up to 55 mg/kg/day 2.
From the Research
Elevated Ferritin Levels
Elevated ferritin levels can be associated with various conditions, including:
- Iron overload
- Acute and chronic inflammation
- Infections
- Malignancies
- Hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS) 3, 4, 5, 6
Causes of Elevated Ferritin
The causes of elevated ferritin levels can be diverse, including:
- Hepatocellular injury
- Infections (e.g., sepsis, septic shock)
- Hematological malignancies
- Rheumatological/inflammatory conditions (e.g., macrophage activation syndrome)
- Solid malignancies 3, 4, 5, 6
Diagnosis and Prognosis
Elevated ferritin levels can be a diagnostic challenge, as they are not specific to a particular condition. However:
- A maximum ferritin value of 9,083 µg/L may be indicative of HLH/MAS 4
- A cut-off of 6,000 µg/L may be associated with HLH diagnosis 5
- The H score can be a useful screening tool to rule out HLH 5
- Elevated ferritin levels may not predict mortality in hospitalized patients 6
Treatment of Iron Overload
In patients with iron overload, treatment options may include:
- Phlebotomy
- Deferasirox (an oral iron chelator)
- Both treatments can reduce iron burden, with a manageable safety profile 7