{"id":4008,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/highferritin\/"},"modified":"2024-03-27T10:33:43","modified_gmt":"2024-03-27T10:33:43","slug":"highferritin","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/highferritin\/","title":{"rendered":"High ferritin"},"content":{"rendered":"\n<p><strong>Definition<\/strong><\/p>\n\n\n\n<p>Increase in ferritin concentration &gt;300ug\/l for men and postmenopausal women or &gt;200 ug\/l for premenopausal women.&nbsp;<\/p>\n\n\n\n<p>Ferritin levels may be increased as an acute phase reactant eg associated with acute liver inflammation.&nbsp; These are often associated with normal transferrin saturation, &lt;50%. &nbsp;High ferritin will also be expected in patients with repeated transfusions, but such patients will usually be under Haematology review.&nbsp;<\/p>\n\n\n\n<p>If transferrin saturation &gt;50% in males or &gt; 40% in females, or there is a family history of haemochromatosis, consider testing for haemochromatosis.&nbsp; Females with haemochromatosis often do not manifest high ferritin till after the menopause.<\/p>\n\n\n\n<p style=\"text-decoration:underline\">Haemochromatosis Gene Screening.<\/p>\n\n\n\n<p><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fapps.nhslothian.scot%2Frefhelp%2Fguidelines%2Fclinicalgenetics%2Fhereditaryhaemochromatosis%2F&amp;data=05%7C02%7CHeather.Levy%40nhslothian.scot.nhs.uk%7Ca7501f936c364afd280208dbfbeedccb%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638380775552096518%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=HEpu2AnB5%2Fr4h299sBAK0W161T96UwiXv4iRilc35iE%3D&amp;reserved=0\">Hereditary Haemochromatosis \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n\n\n\n<p>Haemochromatosis gene screening is done on a red EDTA sample sent to Haematology Laboratory who will then forward on to Molecular Genetics in Dundee for testing.<\/p>\n\n\n\n<p>The various outcomes of testing are:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>C282Y Homozygotes <\/strong>This genotype is associated with highest risk of iron overload and patients should be referred for assessment and monitoring by Haematology.<\/li>\n\n\n\n<li><strong>Compound heterozygotes (C282Y\/H63D)<\/strong><\/li>\n<\/ul>\n\n\n\n<p>This genotype may be associated with iron overload but other causes of elevated ferritin eg alcohol excess or metabolic syndrome should be sought if iron overload present. Please refer.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>H63D homozygotes<\/strong><\/li>\n<\/ul>\n\n\n\n<p>This genotype is not usually associated with iron overload. Other causes of elevated ferritin eg alcohol excess or metabolic syndrome should be sought if iron overload present.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Single gene carriers (H63D or C282Y)<\/strong><\/li>\n<\/ul>\n\n\n\n<p>This genotype is not associated with iron overload.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Non\u2013carriers<\/strong><\/li>\n<\/ul>\n\n\n\n<p>This patient does not carry either of the mutations commonly associated with hereditary haemochromatosis.<\/p>\n\n\n\n<p><strong>C.M &amp; L.W 27-03-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with significantly raised ferritin and high transferrin saturation &gt;50% in males, &gt;40% in females &#8211; Please send HFE gene testing bloods prior to referral<\/li>\n\n\n\n<li>Patients with a genotype associated with haemochromatosis with normal LFTs:\n<ul class=\"wp-block-list\">\n<li>Homozygous for C282Y or H63D<\/li>\n\n\n\n<li>Compound heterozygotes for C282Y\/H63D<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Patients with very high ferritin (&gt;1000 ug\/l) which is unexplained <\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please refer to GI \/ Hepatology:\n<ul class=\"wp-block-list\">\n<li>patients with suspected and\/or confirmed haemochromatosis and abnormal LFTs and<\/li>\n\n\n\n<li>patients with ferritin &gt; 1000 ug\/L.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Patients with clear cause for elevated ferritin eg chronic inflammatory or infective illness, transfusion dependent patient, patient with liver disease including NAFLD\/ALD. Refer to the appropriate specialty if concerning features.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway to Department of Haematology WGH, RIE&nbsp;or St John\u2019s, if no evidence of reactive causes.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Primary care investigations<\/h3>\n\n\n\n<p>(Which help assess for underlying causes e.g. inflammatory conditions, liver disease, malignancy which could cause a reactive rise in ferritin.)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC + film<\/li>\n\n\n\n<li>Biochemistry including renal function, liver function, iron and transferrin, LDH calcium, albumin, urate<\/li>\n\n\n\n<li>Inflammatory markers &#8211; CRP<\/li>\n\n\n\n<li>Haemochromatosis (HFE) gene screening if transferrin saturation &gt;50% in males or &gt;40% in females.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>BSH Guideline: Diagnosis and therapy of genetic haemochromatosis (Review and 2017 update) <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.15164\">https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.15164<\/a><\/p>\n\n\n\n<p>Fitzsimons et al (2018) Investigation and management of raised ferritin <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/bjh.15166\">https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/bjh.15166<\/a>.<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Definition Increase in ferritin concentration &gt;300ug\/l for men and postmenopausal women or &gt;200 ug\/l for premenopausal women.&nbsp; Ferritin levels may be increased as an acute phase reactant eg associated with acute liver inflammation.&nbsp; These are often associated with normal transferrin saturation, &lt;50%. &nbsp;High ferritin will also be expected in patients with repeated transfusions, but such<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3981,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[259],"class_list":["post-4008","page","type-page","status-publish","hentry","category-highferritin"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/highferritin\/\" rel=\"tag\">High Ferritin<\/a>","rttpg_excerpt":"Definition Increase in ferritin concentration &gt;300ug\/l for men and postmenopausal women or &gt;200 ug\/l for premenopausal women.&nbsp; Ferritin levels may be increased as an acute phase reactant eg associated with acute liver inflammation.&nbsp; These are often associated with normal transferrin saturation, &lt;50%. &nbsp;High ferritin will also be expected in patients with repeated transfusions, but such","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4008","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4008"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4008\/revisions"}],"predecessor-version":[{"id":18702,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4008\/revisions\/18702"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3981"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4008"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4008"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}