Serum ferritin concentrations and body iron stores in a multicenter, multiethnic primary-care population.
How often elevated serum ferritin in primary-care patients reflects increased iron stores (normally 0.8 g in men, 0.4 g in women) is not known. The Hereditary Hemochromatosis and Iron Overload Screening (HEIRS) study screened 101,168 primary-care participants (44% Caucasians, 27% African-Americans, 14% Asians/Pacific Islanders, 13% Hispanics, 2% others). Follow-up clinical evaluation was performed in 302 of 333 HFE C282Y homozygotes regardless of iron measures and 1,375 of 1,920 nonhomozygotes with serum ferritin >300 microg/L (men), >200 microg/L (women) and transferrin saturation >50% (men), >45% (women). Quantitative phlebotomy was conducted in 122 of 175 C282Y homozygotes and 122 of 1,102 nonhomozygotes with non-transfusional serum ferritin elevation at evaluation. The estimated prevalence in the Caucasian population of C282Y homozygotes with serum ferritin >900 microg/L at evaluation was 20 per 10,000 men and 4 per 10,000 women; this constellation was predictive of iron stores >4 g in men and >2 g in women. The estimated prevalence per 10,000 of non-C282Y homozygotes with serum ferritin >900 microg/L at evaluation was 7 among Caucasians, 13 among Hispanics, 20 among African Americans, and 38 among Asians and Pacific Islanders, and this constellation was predictive of iron stores >2 g but <4 g. In conclusion, serum ferritin >900 microg/L after initial elevations of both serum ferritin and transferrin saturation is predictive of mildly increased iron stores in multiple ethnic populations regardless of HFE genotype. Serum ferritin >900 microg/L in male C282Y homozygotes is predictive of moderately increased iron stores.
Gordeuk
Victor R
VR
Department of Medicine and Center for Sickle Cell Disease, Howard University, Washington, District of Columbia 20060, USA. vgordeuk@howard.edu
Reboussin
David M
DM
McLaren
Christine E
CE
Barton
James C
JC
Acton
Ronald T
RT
McLaren
Gordon D
GD
Harris
Emily L
EL
Reiss
Jacob A
JA
Adams
Paul C
PC
Speechley
Mark
M
Phatak
Pradyumna D
PD
Sholinsky
Phyliss
P
Eckfeldt
John H
JH
Chen
Wen-Pin
WP
Passmore
Leah
L
Dawkins
Fitzroy W
FW
D015991:Epidemiologic Measurements; D005006:Ethnicity; D005260:Female; D005293:Ferritins / Q000097:blood*; D005838:Genotype; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006801:Humans; D007501:Iron / Q000378:metabolism*; D019190:Iron Overload / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D020125:Mutation, Missense; D018962:Phlebotomy; D011237:Predictive Value of Tests; D015995:Prevalence
C103673:HFE protein, human; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins; D005293:Ferritins; D007501:Iron