A diagnostic approach to hyperferritinemia with a non-elevated transferrin saturation

Abstract

Elevated serum ferritin concentrations are common in clinical practice. In this review, we provide an approach to interpreting the serum ferritin elevation in relationship to other clinical parameters including the patient history, transferrin saturation, serum concentrations of alanine, and aspartate aminotransferases (ALT, AST), testing for HFE mutations, liver imaging, liver biopsy, and liver iron concentration. We used observations from a large series of patients with hepatic iron overload documented by liver iron concentration measurement from two referral practices as a gold standard to guide the interpretation of the predictive values of non-invasive iron tests. Three case studies illustrate common problems in interpreting iron blood tests.

How to Follow up on Unexplained Hyperferritinemia in Primary Care

“…Generally, the patient had high serum ferritin with metabolic syndrome without iron overload (obesity, type 2 diabetes mellitus, hypertriglyceridemia and hypertension) [1,16,17].…”

“…The remainder 5-15% is found in the iron transport protein transferrin, as well as in myoglobin, cytochromes and as unbound serum iron [1]. Elevated Serum Ferritin (SF) is commonly encountered in primary care.…”

Hyperferritinemia in patients with nonalcoholic fatty liver disease

“…Chandok et al 15 studied 482 patients, but only 108 of these subjects underwent histological or radiological investigation and had liver abnormalities compatible with NAFLD. They found that AST/ALT ratio, DM, splenomegaly and age were predictors of the NAFLD stage.…”

En mann i 50-årene med høyt ferritinnivå og økende kognitiv svikt

“…Forbigående økning ses ved akutt inflammatorisk sykdom med økt syntese av ferritin og andre akuttfaseproteiner, og ved tilstander som gir levercelleskade med lekkasje av ferritin, saelig hepatitt og sporadisk overdrevet inntak av alkohol (2). Varig hyperferritinemi ses ved kroniske tilstander som alkoholisme, infeksjon, inflammatorisk sykdom, fettlever, diabetes, enkelte kreftsykdommer, hemolyse og jernoverskudd på grunn av arvelig hemokromatose (1,3).…”