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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
Pontefract
General Infirmary: (01977) 606238 or 606681