Predicting Iron Overload in Hyperferritinemia

Olynyk, John K.; Gan, Eng K.; Tan, Terrence

doi:10.1016/j.cgh.2008.11.010

Cited by 32 publications

(35 citation statements)

References 19 publications

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“…10 Furthermore, even in the presence of an iron loading disorder, ferritin levels below 1000 µg/L have not been shown to increase the risk of adverse clinical outcomes. 11,12,[24][25][26] The correlation of ferritin levels with GGT was not only the strongest of the biomarkers we examined, it was evident for both sexes, remained consistent across all age groups and persisted when adjusted for BMI. The observed associations of both ferritin and GGT with BMI, liver enzymes, lipids and indices of insulin resistance most likely reflect a complex…”

Section: " "mentioning

confidence: 91%

“…[7][8][9][10] The predictive value of elevated serum ferritin levels for iron overload is highest in those individuals with either a history of exposure to exogenously administered iron or blood products, or individuals of northern European descent who are homozygous for the C282Y mutation in the HFE gene. 11 In such individuals, serum ferritin levels >1000 µg/L indicate an increased risk of disease affecting the liver, joints and other organs. 12,13,14 It has been clearly demonstrated that hyperferritinemia outside of these clinical settings is associated with either normal or minimal elevation of hepatic iron concentration to levels not usually associated with ironoverload disease.…”

Section: Introductionmentioning

confidence: 99%

“…12,13,14 It has been clearly demonstrated that hyperferritinemia outside of these clinical settings is associated with either normal or minimal elevation of hepatic iron concentration to levels not usually associated with ironoverload disease. 11,14 While interest exists in iron reduction therapy for amelioration of cancer 6" " risk, improvement of insulin sensitivity in the metabolic syndrome and management of fatty liver disease, at the current time phlebotomy therapy is of no proven value in this group of individuals. [15][16][17][18] Published reference ranges for serum ferritin levels were often derived many years ago and the upper limits of normal, which are mostly in the vicinity of 300-400 µg/L (Supplementary Table 1), are progressively being exceeded by greater numbers of individuals, prompting evaluation for potential iron overload.…”

Section: Introductionmentioning

confidence: 99%

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Factors That Affect Serum Levels of Ferritin in Australian Adults and Implications for Follow-up

McKinnon

Rossi

Beilby

et al. 2014

Clinical Gastroenterology and Hepatology

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Section: " "mentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors That Affect Serum Levels of Ferritin in Australian Adults and Implications for Follow-up

McKinnon

Rossi

Beilby

et al. 2014

Clinical Gastroenterology and Hepatology

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“…Mean LIC was calculated from mean R 2 values as previously reported (12). The accepted normal range of LIC in healthy subjects is Ͻ30 mol/g ( Figure 1) (19). Serum Fe and ferritin concentrations and TSAT were measured or derived using standard methods.…”

Section: Mrimentioning

confidence: 99%

Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease

Ferrari

Kulkarni

Dheda

et al. 2011

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe. Design, setting, participants, & measurements We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L). Results In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis. Conclusions In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis.

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“…Mild elevations of SF < 1000 μg/L are tolerable levels in the absence of HH; the risk of hepatic iron overload is exceedingly low, whereas high elevation of SF > 1000 μg/L requires specialist review to rule out HH with an increased risk of hepatic iron overload, which leads to hepatic fibrosis and cirrhosis [8]. There are many types of hyperferritinemia presented in primary care.…”

Section: Case Study Introductionmentioning

confidence: 99%