From the Guidelines
High ferritin levels should be treated with therapeutic phlebotomy to reduce iron overload and prevent end-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.
Causes of High Ferritin
- Hemochromatosis (a genetic disorder causing iron overload)
- Inflammation
- Liver disease
- Alcohol consumption
- Metabolic syndrome
- Certain anemias
Treatment
- Therapeutic phlebotomy (blood removal) for iron overload conditions, with a typical schedule of removing one unit of blood (about 500 mL) weekly until ferritin levels normalize 1
- Dietary modifications to reduce iron intake may be recommended, including limiting red meat, iron-fortified foods, vitamin C with meals (which enhances iron absorption), and alcohol
- For inflammatory conditions causing high ferritin, treating the underlying inflammation is the primary approach
Monitoring
- Regular monitoring of ferritin levels is important to track progress and adjust treatment as needed 1
- Monitoring of liver iron concentration by MRI (annually) may also be recommended to assess the risk of progressive liver damage It is essential to consult with a healthcare provider for proper evaluation and treatment of high ferritin levels, as the underlying cause and appropriate treatment may vary.
Key Considerations
- Elevated ferritin levels can lead to end-organ damage, including liver disease and heart disease, if left untreated 1
- Regular monitoring and treatment can help prevent these complications and improve quality of life
- The American Association for the Study of Liver Diseases recommends therapeutic phlebotomy as the primary treatment for iron overload conditions, with a target ferritin level of 50-100 μg/L 1
From the Research
High Ferritin Levels
- High ferritin levels can be a sign of iron overload, which can lead to tissue damage and other health problems 2, 3.
- Iron chelation therapy is a treatment option for reducing iron levels and alleviating symptoms associated with iron overload 2, 3, 4, 5, 6.
Treatment Options
- Deferasirox is an oral iron chelator that has been shown to be effective in reducing serum ferritin levels and improving iron overload symptoms 2, 3, 4, 5.
- Deferoxamine is a parenteral iron chelator that is considered the gold standard for iron chelation therapy, but its use can be limited by the need for daily infusions 3.
- Combination therapy with deferiprone and deferasirox has been shown to be effective in reducing iron overload and improving cardiac and liver function in patients with transfusion-dependent β-thalassemia major 6.
- Dual chelation therapy with deferasirox and deferoxamine has been shown to be effective in reducing serum ferritin levels and improving liver iron loading in patients with beta thalassaemia major 5.
Monitoring and Dosage
- Serum ferritin levels should be monitored regularly to assess the effectiveness of iron chelation therapy 2, 3, 4, 5, 6.
- The dosage of iron chelators should be adjusted based on serum ferritin trends and safety markers 3, 4.
- MRI can be used to monitor cardiac and liver iron loading, and to assess the effectiveness of iron chelation therapy 3, 5, 6.