How to manage elevated ferritin levels (hyperferritinemia) of 1710?

From the Guidelines

To manage a ferritin level of 1710, therapeutic phlebotomy is the recommended treatment, with a target ferritin level of 50-100 lg/L, as stated in the 2022 EASL clinical practice guidelines on haemochromatosis 1.

Key Considerations

• The induction phase of phlebotomy should be performed weekly or fortnightly until iron stores are depleted, with a target serum ferritin of 50 lg/L, but not lower to avoid iron deficiency 1.
• During the maintenance phase, serum ferritin can be maintained with some flexibility in the range of 50-100 lg/L, with phlebotomy performed every 1-4 months, depending on the patient’s iron status 1.
• Serum haemoglobin should always be monitored during both induction and maintenance phases, at the time of each bloodletting session, and if haemoglobin concentrations are <12 g/dl, the frequency of phlebotomy should be decreased 1.
• Serum ferritin should always be monitored to ensure that the target value is achieved and maintained and to avoid overtreatment, with measurements every month during the induction phase and every 6 months during the maintenance phase 1.

Additional Recommendations

• Dietary modifications are also important, including limiting iron-rich foods, vitamin C supplements, and alcohol consumption, which can worsen liver damage 1.
• Regular monitoring of liver function tests and other relevant parameters will be necessary to track progress, as high ferritin levels can lead to serious complications, including liver cirrhosis, heart problems, diabetes, and joint damage if left untreated 1.
• It is advisable to periodically check plasma folate and plasma cobalamin, especially in patients who require numerous venesections, and if necessary, vitamin supplements should be administered 1.

From the FDA Drug Label

The average daily dose of Desferal is usually between 20 and 60 mg/kg. In general 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.

For a patient with a ferritin level of 1710, the recommended dose of Deferoxamine (Desferal) would be around 25 mg/kg/day 2.

• The dose should be individually determined and adapted during the course of therapy based on the severity of the patient's iron overload.
• The minimum daily dose is 20 mg/kg/day and the maximum daily dose is 60 mg/kg/day for adults.
• It is essential to monitor the patient's ferritin levels and adjust the dose accordingly to avoid toxicity.
• Deferiprone may also be considered as an alternative treatment option for managing iron overload, with a recommended dose of 35 to 99 mg/kg/day 3.

From the Research

Managing Elevated Ferritin Levels

To manage a ferritin level of 1710, it is essential to consider the following approaches:

• Iron chelation therapy: This involves using medications that bind to excess iron in the body and help remove it. Studies have shown that iron chelation therapy can effectively reduce serum ferritin levels 4, 5, 6.
• Combination therapy: Using a combination of iron chelators, such as deferoxamine and deferiprone, may be more effective in reducing serum ferritin levels than using a single agent 5, 6.
• Monitoring and adjusting treatment: Regular monitoring of serum ferritin levels and adjusting treatment as needed is crucial to ensure that ferritin levels are adequately controlled 4, 5, 6.

Optimal Serum Ferritin Level Range

Research suggests that optimal serum ferritin levels for cardiovascular mortality reduction may range from 20 to 100 ng/mL, with transferrin levels between 20% and 50% 7. Ferritin levels above 194 ng/mL have been associated with all-cause mortality in population cohorts.

Safety and Efficacy of Iron Chelation Therapy

The safety and efficacy of iron chelation therapy, particularly with deferiprone and deferoxamine, have been established in several studies 4, 5, 6, 8. However, the high cost of these medications may limit their accessibility, especially in developing countries 8.

Key Considerations

When managing elevated ferritin levels, it is essential to consider the following:

• The potential benefits and risks of iron chelation therapy
• The importance of regular monitoring and adjusting treatment as needed
• The optimal serum ferritin level range for cardiovascular mortality reduction
• The safety and efficacy of different iron chelators, including deferiprone and deferoxamine.