Hyperferritinaemia

Availability

North South North West Statewide

Pre-referral work-up

History

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

All referrals should comply to 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 (<500 ug/L) with transferrin saturation <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 >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 >45% is a useful, accessible screening tool for possible hereditary haemochromatosis.  If transferrin saturation is <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 >500 ug/L; Transferrin saturation >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.

For more information please see the Tasmanian Health Pathways website.

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489 - Discuss with the on call Haematologist/Registrar via switch (03) 6166 8308

Urgent:

Urgent Referrals generally need to be seen in the next one to two weeks

Please discuss these with the Haematology Registrar/Haematologist on call via switchboard on 6166 8308

Semi-urgent:

Triaged by medical staff and generally seen in the next six to eight weeks

Routine:

Triaged by medical staff and given the next available appointment