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?

Now let’s move on to the history