How to manage high iron levels?

Question

Hi doctor,

My mother has been transfused with at least 11 to 12 units of blood during a period of two months. This was done on a false diagnosis of iron deficiency anemia. It was a false diagnosis because the transferrin receptor was never used to come to this diagnosis. She has had elevated CRP for a while now because of proctitis. The doctor monitored her free serum iron and transferrin saturation, which have been low for a while now. Although, her ferritin got elevated after her stay in the hospital. The iron and transferrin saturation are still low, but ferritin is swinging between 1300 and 1700 depending on CRP. Every time, CRP falls below 25 and the ferritin gets elevated to 1700. Now, an MRI of the liver and spleen show increased iron concentration (670.39 µg/dL) and moderate iron overload in the spleen. Her symptoms and findings are severe skin pigmentation, hair loss, elevated amylase and lipase, total loss of appetite, cardiac arrhythmia, pulmonary hypertension, etc. She tested negative for the C282Y gene mutation. What do you think of this?

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows,

Normally in hemochromatosis (iron deposition disease), serum transferrin, iron, and ferritin levels will be usually high. All the symptoms and signs point towards hemochromatosis, possibly due to iron overloading secondary to multiple transfusions.
CRP levels (C-reactive protein) and ferritin levels are usually increased together. Here, possibly due to iron overload and associated inflammation, they are not rising together.
She will require management through phlebotomy (vein puncture) and control of ferritin levels. Need to re-evaluate her after a month with the reports.

I hope this helps you.

Take care.