From the Guidelines
Elevated iron saturation is a condition that requires immediate medical attention, as it can lead to iron overload disorders like hemochromatosis, which can cause irreversible organ damage if left untreated. This condition occurs when the percentage of transferrin (the protein that transports iron in blood) bound to iron exceeds normal levels, typically above 45% 1. According to the EASL clinical practice guidelines on haemochromatosis 1, early diagnosis and treatment by phlebotomy can prevent cirrhosis, hepatocellular carcinoma, diabetes, arthropathy, and other complications.
Diagnosis and Treatment
To diagnose iron overload, healthcare providers typically perform additional blood tests, such as serum ferritin, total iron binding capacity, and possibly genetic testing for hereditary hemochromatosis 1. Treatment depends on the underlying cause but often involves therapeutic phlebotomy (blood removal) for confirmed iron overload 1. The treatment targets for phlebotomy are ferritin <50 µg/L during the induction phase and <100 µg/L during the maintenance phase 1.
Dietary Modifications and Monitoring
Dietary modifications are also essential, including limiting iron-rich foods, vitamin C (which enhances iron absorption), and alcohol (which can worsen liver damage) 1. It is also recommended to avoid iron supplements and raw shellfish (which may contain bacteria harmful to those with iron overload) 1. Regular monitoring of iron levels is essential to prevent complications such as liver disease, diabetes, heart problems, and joint pain 1.
Role of MRI in Diagnosis and Management
MRI can be helpful in detecting, non-invasively quantifying iron, and studying the distribution of iron in the liver, spleen, pancreas, heart, and brain in patients with suspicion or diagnosis of iron overload disorder 1. In patients homozygous for the p.C282Y variant of the HFE gene, with elevated transferrin saturation and hyperferritinemia without additional risk factors, non-invasive assessment of tissue iron overload by MRI is not required for the diagnosis, but enables determination of the degree of iron overload, which is a predictor of organ damage 1.
Key Points to Consider
- Elevated iron saturation can lead to iron overload disorders like hemochromatosis
- Early diagnosis and treatment by phlebotomy can prevent complications
- Dietary modifications and regular monitoring of iron levels are essential
- MRI can be helpful in detecting and managing iron overload disorder
- Treatment targets for phlebotomy are ferritin <50 µg/L during the induction phase and <100 µg/L during the maintenance phase 1
From the FDA Drug Label
Deferasirox tablets are an iron chelator indicated for the treatment of chronic iron overload due to blood transfusions in patients 2 years of age and older. The answer to elevated iron saturation is that deferasirox is used to treat chronic iron overload.
- Key points:
- Deferasirox is an iron chelator.
- It is indicated for patients with chronic iron overload due to blood transfusions.
- The treatment is for patients 2 years of age and older. 2
From the Research
Elevated Iron Saturation
Elevated iron saturation is a condition where the body has an excess of iron, which can lead to various health problems. The following points highlight the key aspects of elevated iron saturation:
- Elevated iron saturation can be diagnosed using serum ferritin concentration and transferrin saturation, as stated in the study 3.
- Transferrin saturation is a useful diagnostic criterion for iron deficiency, and using it in addition to ferritin can improve the diagnosis of iron deficiency, especially in patients with chronic inflammatory diseases 4.
- Iron overload disorders can lead to end-organ damage, and an elevated ferritin and transferrin-iron saturation can be commonly encountered in the evaluation of elevated liver enzymes 5.
- Glycosylated ferritin may be a potential marker for transfusion-related iron overload, and its optimal cutoff value for iron overload is >587.55 ng/mL, as found in the study 3.
- Iron homeostasis plays a crucial role in regulating immune function and inflammatory disease, and understanding this complex process can help develop new therapeutic strategies for inflammatory disease 6.
Diagnosis and Treatment
The diagnosis and treatment of elevated iron saturation involve the following:
- Serum ferritin concentration and transferrin saturation are commonly used to estimate body iron, but they are non-specific to iron overload 3.
- Magnetic resonance imaging with quantitative assessment of iron content or liver biopsy can be used to confirm the diagnosis of iron overload 5.
- Iron chelation therapy can be used to treat iron overload, and the optimal cutoff value for initiating therapy is >587.55 ng/mL of glycosylated ferritin 3.
- Targeting ferroptosis, iron homeostasis, and/or iron metabolism can have therapeutic implications for conferring protection against pathogen infection, controlling inflammation, and improving the efficacy of immunotherapy 6.
Key Findings
The key findings related to elevated iron saturation are:
- Elevated ferritin and transferrin-iron saturation can be commonly encountered in the evaluation of elevated liver enzymes 5.
- Glycosylated ferritin shows a positive correlation with ferritin and transferrin saturation, which is statistically significant 3.
- The use of ferritin as a diagnostic test of iron deficiency and overload is a common clinical practice, but its levels are elevated in inflammation and infection 7.
- Transferrin saturation is a useful diagnostic criterion for iron deficiency, and using it in addition to ferritin can improve the diagnosis of iron deficiency 4.