High ferritin

Acceptability at Recruitment

DISCUSS with MO

Acceptability at CT / Work-Up

DISCUSS with MO

Individual at Risk

Donor/ Recipient

Explanation of Condition

Whilst low serum ferritin levels invariably indicate reduced iron stores, raised serum ferritin (hyperferritinaemia) can be due to a multitude of different aetiologies. Serum ferritin is an acute phase response when levels are raised by inflammation or tissue damage. Causes of raised serum ferritin can include iron overload, inflammation, liver or renal disease, metabolic syndrome, or in some instances malignancy. (Cullis et al, 2018)

Raised serum ferritin is common with approximately 20% of white males having serum ferritin values >300 ug/l (Ogilvie et al, 2010, Adams et al, 2013)

Upper limit of normal range: This will depend on the assay used by the Collection Centre laboratory and local reference ranges should be reviewed. Most UK laboratories report 300-400 ug/l as the upper limit of normal for SF in adult males and 150-200 ug/l as the upper limit of normal for adult females.

Mean SF levels are higher in the Black and Asian populations. (Adams et al, 2005)

Establish: - Any history of current infection/inflammation - Any history of inflammatory medical conditions or symptoms of autoimmune disease - Review alcohol consumption - Review weight, glucose and blood pressure - Review if previous history of transfusions or oral iron supplementation - Review if any weight loss, fevers, night sweats, loss of appetite, unexplained fatigue, change in bowel habit or breast lumps - Review liver function results and renal function - Donor’s ethnicity

Guidance

Raised Ferritin >300 ug/l male, >200 ug/l female (or upper limit of normal by gender by the reporting laboratory), but <1000 ug/l. If other bloods normal and no symptoms can be cleared.

If abnormal LFTs <3 x ULN or raised BMI >30 arrange for US abdomen to look for fatty liver. Can clear if fatty liver and LFTs within acceptable thresholds (see Abnormal liver function) and no other cause of high ferritin suspected. Inform TC

If abnormal LFTs >3 x ULN. Can not be cleared. Consider Gastroenterology referral and non-invasive fibrosis assessment with Fibroscan if ferritin >500ug/l.

If abnormal FBC, review haemoglobinopathy screening, consider causes of ineffective erythropoiesis and refer to Haematology for assessment. Raised ferritin >1000ug/l.

Arrange for repeat bloods to include: - Repeat ferritin, transferrin saturation and iron studies - Repeat LFTs and FBC if any abnormalities in initial results - Check CRP, ESR. - If any concern/symptoms of autoimmune disease; check autoimmune screen (ANA, ANCA, RF)

If raised CRP, review for infection and defer donation until resolved.

If Transferrin saturations raised (>50% male, >40% female) perform genotyping for Genetic haemochromatosis. If confirmed C282Y heterozygote or compound heterozygote C282Y/h63d then formally refer for iron overload assessment (Haematology and gastroenterology with fibroscan assessment and echocardiography/cardiac MRI). Can be cleared to donate if no evidence of iron overload.

If Transferrin saturations are not raised cannot be cleared. Review for possible autoimmune, inflammatory conditions or malignancy. Refer to gastroenterology for formal assessment of iron overload in the liver with fibroscan.

Pseudonyms or Related Conditions

Hyperferritinaemia

Haemochromatosis

Kidney Disease

Liver Function, Abnormal

Infection, Acute

Malignancy

References

Cullis, J, Fitzsimons, E, Griffiths W, Tsochatzis E, Thomas DW on behalf of the British Society for Haematology. Investigation and management of a raised serum ferritin. British Journal of Haematology, 2018, 181, 331–340

Adams, P.C., McLaren, C.E., Speechley, M., McLa-ren, G.D., Barton, J.C. & Eckfeldt, J.H. (2013)HFE mutations in Caucasian participants of thehemochromatosis and iron overload screeningstudy with serum ferritin level <1000 lg/l. Cana-dian Journal of Gastroenterology, 27, 390–392

Ogilvie, C., Fitzsimons, K. & Fitzsimons, E.J.(2010) Serum ferritin values in primary care: arehigh values overlooked? Journal of ClinicalPathology, 63, 1124–1126

Version

Version 1, Edition 1

Date of Last Update

4th October 2021