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High ferritin: causes and treatments

High ferritin: causes and treatments


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There ferritin it is a molecule that is used by our body to "conserve" and store iron. It is a water-soluble molecule, and its level in the blood is proportional to the body's total ferritin and, in most cases, to the body's total iron. A low serum ferritin is therefore recognizable only in a state of iron deficiency, while a high serum ferritin may have various causes. Let's see them together.

Causes of high ferritin

High ferritin can be caused by some main and recurring factors, such as:

  • damage to ferritin-containing tissues (e.g. bone marrow and liver);
  • inflammation or infection, as ferritin is an acute phase protein;
  • genetic conditions;
  • secondary conditions, mainly due to blood transfusions;
  • chronic anemias caused by ineffective hematopoesis, for example thalassemias.

Of course, not always the high ferritin it is the result of a pathology. For example, the increase in ferritin due to tissue damage or as part of the inflammatory process is not a sign of iron overload and does not alone cause a pathological state. Furthermore, genetic conditions are very rare in Northern Europe, with the exception of hereditary hemochromatosis type 1.

Patients who receive a blood transfusion for anemia other than that caused by iron deficiency or blood loss are certainly at risk of excess iron, and therefore may have a increased ferritin level. Finally, in chronic anemias, the drive to produce red blood cells causes the absorption of excess iron but, unless there is a further transfusion, this is unlikely to cause a clinically detectable excess.

High Ferritin Diagnosis

As mentioned, high ferritin is often caused by tissue damage or as part of the acute phase response. In these cases, it does not require treatment and can be diagnosed by measuring the fasting transferrin saturation.

In cases where excess iron is deposited in the tissues leading to an inflammatory reaction and tissue damage, generally the areas of the body affected will be those in the liver, heart, skin, musculoskeletal and endocrine systems. The clinical features are in this case related to the presence of cirrhosis with progression to hepatocellular carcinoma; heart failure and arrhythmias; osteoarthritis; slate gray skin pigmentation; and hypothyroidism, hypoadrenalism, diabetes, impotence and hypoparathyroidism.

L'hereditary hemochromatosis it must also be considered in the diagnosis of patients with a history of one of these conditions, in which no other obvious causes have been found. Patients receiving blood transfusions should also be monitored for signs of iron overload and increasing ferritin that may need treatment. L'genetic hemochromatosis it can usually be diagnosed with laboratory tests.

High ferritin treatment

High ferritin doesn't always require treatment. It is therefore advisable to speak with your doctor in order to interpret the ferritin analysis data and, above all, integrate them with any other data that emerged from the blood test.

In other cases, such as in non-transfusion dependent patients, the venesectomy it can be used to reduce total body iron, and for those who are transfusion addicted or cannot tolerate venesectomy, pharmacological iron chelation is required. In cases where it is customary to have a venous injection, 300 - 400 ml of blood is taken, usually in a similar way to a donation. This process could also take place every 7-10 days but it is evident that careful monitoring of the complete blood count will be necessary for prevent the development of anemia.

The aim of the procedure is to bring the patient into a condition of iron deficiency and thus obtain a ferritin lower than 50 (mu) g / l. However, this is not generally the "primary" procedure, but is only recommended if the doctor believes that there is a real risk of tissue damage if you do not proceed in reverse. Once the ferritin has reached an acceptable level, the frequency can be reduced.

In patients receiving transfusions, for example patients with thalassemia, treatment to ward off a high ferritin content is usually indicated when the level reaches 1,000 (mu) g / L.

The use of drugs

It is also possible to proceed with the pharmacological administration, using authorized medicines to favor iron chelation.

Some of these medicines are administered subcutaneously. Side effects generally include a feeling of pain or discomfort at the injection site, ototoxicity and retinopathy, gastrointestinal upset, asthma, fever, headache, arthralgia and myalgia.

This first class of drugs, also due to the high side effects, was then followed by another class which is instead administered orally. Side effects are more limited in this case, and could include gastrointestinal upset, headache, proteinuria, itching and rash.

Overall, a high ferritin condition is not uncommon. The clinical history should make it possible to identify the causes or guide the doctor towards the most plausible reasons, especially when there are no links to an obvious infection, inflammation or other contextual pathologies.


Video: Iron Metabolism, Serum iron, TIBC and Ferritin Explained (July 2022).


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