Approach to High Ferritin
from NOSMSS Student-led MCS Podcast Hosted by NOSMSS
Podcaster: Caitlyn Vlasschaert Medical Discipline/Topic: Hematology, Internal Medicine Intended Audience Year 1, Year 2, Year 3, Year 4 Brief Synopsis/Key Takeaways: 1. Think of the 4 major AOLI causes (alcohol, overload, liver, inflammation), keeping in mind that several are likely contributing in one patient. 2. Transferrin saturation >45% is highly suggestive of iron overload as a contributing factor, including hemochromatosis, and would warrant referral to hematology. Other key tests to order include: CBC, ESR, CRP, Cr and lytes, LFTs and hepatitis serology (B and C), abdominal U/S, glucose, A1C, lipids, and HFE gene testing if you’re suspicious of hemochromatosis. 3. Good rule of thumb: High ferritin is anything >300, but for those in the 300-1000 range, lifestyle modification targeting the non-iron overload causes is appropriate, with hematology referral for ferritin above 1000 as this plus high transferrin saturation is specific for hemochromatosis and phlebotomy may be necessary. Alcohol cessation is also recommended in hemochromatosis.
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