Hyperferritinaemia

This condition is treated in the Haematology (including oncological disorders) clinic.

Pre-referral work-up

History

Gastroenterology referral is suggested if there are abnormal liver function tests.

All referrals should comply to referral standards referral standards and include in particular:

• Relevant investigations, including previous results to assess temporal pattern
• Causes of elevated ferritin are varied and include inflammatory, infective and genetic causes

Appropriate features on history, examination and iron studies interpretation may suggest an underlying cause

Tests

Consider some general principles that guide the appropriate investigation and management of elevated ferritin/iron overload. 

• Mild hyperferritinaemia (under 500 ug/L) with transferrin saturation under 45% is very unlikely to represent a clinically significant iron overload syndrome and can be observed in the first instance
• More significant hyperferritinaemia (e.g. Ferritin over 750 ug/L) can still have a number of causes, including but not limited to:
  • Hereditary haemochromatosis
    • C282Y homozygote/heterozygote
    • H63D homozygote/heterozygote
    • Compound heterozygote
  • Systemic inflammation
  • Liver disease of any cause
  • Malignancy
• Transferrin saturation over 45% is a useful, accessible screening tool for possible hereditary haemochromatosis.  If transferrin saturation is under 45%, a clinically significant iron overload syndrome (e.g. C282Y homozygote hereditary haemochromatosis) is unlikely
• If a patient has genotypic hereditary haemochromatosis and biochemical suggestion of iron overload (Ferritin over 500 ug/L; Transferrin saturation over 45%), assessment for end-organ dysfunction may include:
  • Liver function tests

Assessment for presence of ultrasound evidence of cirrhosis (alpha-feto-protein if cirrhosis)

Interim/GP management

To refer a patient with this condition, please see the Haematology clinic page for the full referral process and templates.

• The Australian Red Cross Blood Service (ARCBS) run a therapeutic venesection program for patients with established hereditary haemochromatosis and can be referred via their High Ferritin App (https://highferritin.transfusion.com.au)
• Concerned patients with elevated ferritin and no evidence of iron overload who are otherwise eligible should be encouraged to become blood donors (see http://www.donateblood.com.au/who-can-give/am-i-eligible for eligibility criteria)

For more information please see the HealthPathways Tasmania website.

Availability

North

Launceston General Hospital
Level 1 - W.P. Holman Clinic
Phone: 03 6777 6140
Fax: 03 6331 6371

North West

North West Regional Hospital > Mersey Community Hospital
Torquay Road Latrobe TAS 7307

Visit Northern Cancer Service

South

Royal Hobart Hospital (Level 1 - A Block)

Phone (appointments): 03 6166 6655
Phone (clinic nurses): 03 6166 6637
Fax: 03 6173 0484