From the Guidelines
High ferritin levels should be treated with therapeutic phlebotomy to reduce iron overload and prevent organ damage, with a target ferritin level of 50-100 μg/L, as recommended by the American Association for the Study of Liver Diseases 1. The normal range for ferritin is typically 20-250 ng/mL for men and 10-120 ng/mL for women, though reference ranges may vary between laboratories.
- High ferritin can result from hereditary hemochromatosis, alcoholic liver disease, inflammatory conditions, or metabolic syndrome, so identifying and treating the underlying cause is essential.
- Left untreated, excess iron can damage organs including the liver, heart, and pancreas, potentially leading to cirrhosis, heart failure, diabetes, and other complications.
- Regular monitoring of ferritin levels is crucial, especially in patients with transfusion-dependent anemia, as elevated ferritin levels (>1000 μg/L) can worsen survival and increase the risk of cardiac disease 1.
- Dietary modifications, such as reducing red meat and alcohol consumption, and avoiding iron supplements, may also be recommended to help manage high ferritin levels.
- In some cases, medications like deferasirox (Exjade, 20-40 mg/kg/day) or deferoxamine may be prescribed for severe cases of iron overload.
- It is essential to note that the management of high ferritin levels should be individualized, taking into account the underlying cause and the patient's overall health status, as well as the potential risks and benefits of treatment, as highlighted in the consensus statement on iron overload in myelodysplastic syndromes 1.
From the Research
High Ferritin Levels
- High ferritin levels can be a sign of iron overload, which can be caused by various factors such as transfusion-dependent anemias or hemochromatosis 2, 3.
- Iron chelation therapy, such as deferasirox, can be an effective treatment for reducing ferritin levels and managing iron overload 2, 3, 4, 5.
- Deferasirox has been shown to be a safe and effective means of substantially lowering ferritin levels in patients with hyperferritinemia and hemochromatosis-associated HFE genotypes 2.
- The effectiveness of deferasirox in reducing ferritin levels can be influenced by factors such as transfusional iron intake, baseline body iron burden, and serum ferritin trends 3.
Treatment Options
- Iron chelation therapy with deferasirox can be tailored to individual patients based on their transfusional iron intake and serum ferritin levels 3.
- Combination therapy with deferasirox and hydroxyurea may provide an additional benefit of iron chelation in patients receiving chronic transfusion therapy 5.
- Deferiprone and deferasirox have been shown to have different effects on iron elimination rates, with deferiprone appearing to have a significantly larger effect 6.
Patient Response
- Individual patient response to chelation therapy can vary depending on factors such as baseline demographic and clinical characteristics, annual blood consumption, and ferritin concentrations at baseline 6.
- Modeling of serum ferritin following chronic blood transfusion can enable the evaluation of drug-induced changes in iron elimination rate and ferritin production 6.