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?
a
Do you have a history of therapeutic phlebotomies?