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I would appreciate advice from anyone with experience of ferritin levels in patients who have taken oral iron for a long time. A healthy 61 year old lady is being seen at one of our hospitals - diagnosed with a hypochromic microcytic anaemia, ascribed to menorrhagia, in early 1996. She was placed on ferrous sulphate (at the same time as starting thyroxine therapy - her TSH was 102). No iron studies were done at the time. She felt much better after a few months (Hb went from 8.1 to 11.8 g/dl) and stayed on both forms of treatment for 7 years (2003) until the GP discovered that her ferritin level was 1851, stopped the iron treatment and referred her to Haematology. At that stage her serum iron level was 34.0 umol/L (11-32), transferrin 1.94 g/L (2.2-4.0) and transferrin saturation 79%. She used virtually no alcohol, her weight at the time was 64 kg and she was healthy otherwise. A liver ultrasound showed diffuse increased echogenicity, suggestive of fatty infiltration. Neither the H63D not the C282Y gene mutations for haemochromatosis were present. She was subsequently seen by a gastroenterologist who found negative autoantibodies, hepatitis serology and clinical examination. Liver biopsy in November 2004 showed normal architecture, no evidence of cirrhosis, a mild degree of macrovesicular steatosis, deposition of iron within Kupfer cells and focal grade 1 intrahepatocyte iron deposition - described as a non-specific finding and not of a significant level to indicate haemochromatosis. Up to that stage her ferritin levels fluctuated a bit, but remained elevated: 2003: 1851, 1754, >2000 2004: 1140, 1220, 1274, 1808 Since she remained asymptomatic she was simply followed up, although the question came up a few times whether venesection was indicated. Further ferritin levels were: 2005: 1142, 1182, 1155 2006: 1073 2007: January: 779 and 877 (ALT levels, which had been slightly elevated throughout, but never >110, are now within the reference range). (Transferrin saturation not measured recently). The question is whether these levels are attributable purely to the long period of iron therapy or whether something else should still be looked for. Thanks in anticipation Marieke Dr Marieke Jordaan Consultant Chemical Pathologist Mid-Yorkshire Trust Pinderfields General Hospital: (01924) 212656 Pontefract General Infirmary: (01977) 606238 or 606681 ------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/