This is also known as Macrophage Activation Syndrome. I presented a
similar case at FOCUS this year of a patient with Hodgkin's lymphoma
whose serum ferritin peaked at 166,187ug/L. It is a rare disorder with a
high fatality rate and is associated with rheumatic conditions,
infections and lymphoma.
Normally serum ferritin is made up of light chains and > 50%
glycosylated. However in MAS ferritin is Heavy (H) chain rich
and < 20% glycosylated. H chain ferritin exerts
immunomodulatory activity. Hyperferritinaemia in MAS may be
part of an inefficient anti-inflammatory feedback loop.
Hypothesised mechanisms of Hyperferritinaemia in MAS
1 Passive release due to cell damage
2 Increased secretion by macrophages and / or release during
erythrophagocytosis
3 Decreased clearing due to lower glycosylation and / or down regulation
of putative ferritin receptors
Elinor Hanna
Consultant Chemical Pathologist
Princess of Wales Hospital
Bridgend
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Sarah Mapplebeck
Sent: 12 October 2006 11:46
To: [log in to unmask]
Subject: Significantly elevated Ferritin ? Stills Disease ?
We have a 46yr old lady admitted to ITU following arrival in A&E feeling
unwell (?). She is still without a clear diagnosis despite 2 weeks in
ITU...
The question is regarding Adult Onset Stills Disease..
Serum Ferritin (02/10/2006) 56,500ng/ml ? AOSD ? which started to
decline
on steroids - Serum Ferritin (06/10/2006) 9,000ng/ml. However, this has
now
shot up to 112,000 (11/10/2006) and 138,000 (12/10/2006).
Is anyone aware of the mechanism for the significantly elevated Ferritin
seen in AOSD? I have found reports of levels up to 250,000 - is this
correct? Any advice would be gratefully received.
Many thanks and best wishes
Sarah
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
Cymraeg:-
Mae'r neges hon yn gyfrinachol.Os nad chi yw'r derbynnydd y bwriedid y neges ar ei gyfer, byddwch mor garedig â rhoi gwybod
i'r anfonydd yn ddi-oed. Dylid ystyried un rhywd datganiadau neu sylwadau a wneir uchod yn rhai personol,ac nid o angen rhaid yn rhai o
eiddo Ymddiriedolaeth GIG Bro Morgannwg, nac unrhyw ran gyfansoddol ohoni na chorff cysylltiedig.
Cofiwch fod yn ymwybodol ei bod yn bosibl y bydd disgwyl i Ymddiriedolaeth GIG Bro Morgannwg roi cyhoeddusrwydd i gynnwys unrhyw ebost neu
ohebiaeth a dderbynnir, yn unol ag amodau'r Ddeddf Rhyddid Gwybodaeth 2000. I gael mwy o wybodaeth am Ryddid Gwybodaeth, cofiwch gyfeirio
at wefan Ymddiriedolaeth GIG Bro Morgannwg ar www.bromor-tr.wales.nhs.uk
English:-
This message is confidential. If you are not the intended recipient of the message then please notify the sender immediately.
Any of the statements or comments made above should be regarded as personal and not necessarily those of Bro Morgannwg NHS Trust, any
constituent part or connected body.
Please be aware that, under the terms of the Freedom of Information Act 2000, Bro Morgannwg NHS Trust may be required to make public the
content of any emails or correspondence received. For further information on Freedom of Information, please refer to the Bro Morgannwg NHS
Trust website at www.bromor-tr.wales.nhs.uk.
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|