Preparing to see the patient

You have been given limited information about the patient, namely that she has a chronically elevated serum ferritin level. When approaching a patient with an elevated ferritin, there are three main diagnostic “buckets” to think about:

Let’s consider each in turn:

  • Iron overload:
    • Hereditary hemochromatosis
    • Transfusional iron overload
    • Iron overload secondary to ineffective hematopoiesis
  • Inflammation:
    • Non-malignant inflammatory conditions, including hemophagocytic lymphohistiocytosis (HLH)
    • Malignancy
  • Cell leak:
    • Acute liver failure
    • Alcohol
    • HLH

Now that you are armed with a broad differential diagnosis, which of the following questions are relevant?

Do you have a history of therapeutic phlebotomies?
Are you a heavy drinker?
Do you have a history of liver disease?
Do you have a history of recurrent hematuria?

Now let’s move on to the history