Dr. Mian Shah Yousaf
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 52-year-old male (5 foot 7 inches, 157 pounds) with no symptoms. I had some routine annual lab tests performed three months back, I had an elevated Ferritin level of 325.9 (normal is 40 to 250 ng/mL). So I had more comprehensive lab tests done last week. Please see attached lab reports. You will see under "iron and total iron-binding capacity" that the iron-binding capacity is 247 (normal is 250 to 425), so this is slightly low. But the saturation percentage is 65 (normal is 20 to 48%), so this is elevated. The total iron is 161 (normal 50 to 180), which is normal.
Also, my cholesterol was 236 (normal is below 200) and my HDL was mildly high at 44 (normal is 40 or lower); triglycerides were 218 which is high. Everything else was normal, including CBC and liver function tests, normal hemoglobin level, normal TSH, normal C-reactive protein, normal sedimentation rate, etc. My only past medical history is that I am mildly hypertensive and I take Amlodipine. I also intake natural garlic pills to control my cholesterol and I also take children's multivitamins. Sometimes I take Zolpidem for insomnia.
My question is should I be very concerned about this abnormal iron saturation percentage of 65 %? Does this imply that I could have early hemochromatosis? As I mentioned, I have no symptoms, and this was an incidental finding. I have not been tested for iron-binding capacity before, but my total iron levels in the past recent years have always been normal. I do not drink alcohol, and my parents never had liver diseases or were diagnosed with hemochromatosis. What are your suggestions for a follow-up? I was thinking of improving my diet and repeating lab tests in six months. What do you think?
Hello,
Welcome to icliniq.com.
I reviewed all your tests (attachments removed to protect the patient's identity).
Your serum transferrin saturation suggests hemochromatosis, but it is an initial screening test, and your ferritin is not that high. Your liver enzymes are also normal, so there is nothing to worry about. However, I suggest these iron studies should be repeated after six months. If they remain persistently high, you should undergo genetic testing for hemochromatosis, an ATP7B mutation.
You do not need any statins at the moment. Your lipid profile can be easily controlled with exercise and dietary changes.
If you have any further queries, please reach back.
Thank you.
Patient's Query
Hi doctor,
Thank you for your quick response. But does it mean I have hemochromatosis right now? Or still indeterminate and borderline? If not hemochromatosis, what else could it be?
So bottom line, I do not have to be too concerned right now? Just repeat in six months?
Thank you, doctor.
Hi,
Welcome back to icliniq.com.
You are welcome. It is indeterminate at the moment.
Yes, you do not have to be too much concerned at the moment as the rest of all your liver parameters are normal—just a repeat of iron studies in six months. But as your ALT (alanine transaminase) is normal and ferritin is well below 1000 nothing to worry about. So there is no damage going on in the liver. It can be a simple secondary iron overload.
I suggest avoiding iron-containing foods.
Thank You.
Patient's Query
Hi doctor,
Thank you for your quick response.
But does it mean I have hemochromatosis right now? Or still indeterminate and borderline? If not hemochromatosis, what else could it be? So bottom line, I do not have to be too concerned right now? Just repeat in six months?
Thank you, doctor.
Hi,
Welcome back to icliniq.com.
I suggest concentrating on regular exercise and some weight loss and avoiding iron-loaded foods.
You will be better with all these and nothing to worry about.
Thank you.
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