North South North West Statewide
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
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
- Hereditary haemochromatosis
- 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)
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 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.
Proceed to Emergency Department (ED).
LGH ED Reception – Phone: (03) 6777 6405 Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120 Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100 Fax: (03) 6173 0489
Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.
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
Triaged by medical staff and generally seen in the next six to eight weeks
Triaged by medical staff and given the next available appointment