title: A diagnostic approach to hyperferritinemia with a non-elevated transferrin saturation.
abstract: Elevated serum ferritin concentrations are common in clinical practice. In this review, we provide an approach to interpreting the serum ferritin elevation in relationship to other clinical parameters including the patient history, transferrin saturation, serum concentrations of alanine, and aspartate aminotransferases (ALT, AST), testing for HFE mutations, liver imaging, liver biopsy, and liver iron concentration. We used observations from a large series of patients with hepatic iron overload documented by liver iron concentration measurement from two referral practices as a gold standard to guide the interpretation of the predictive values of non-invasive iron tests. Three case studies illustrate common problems in interpreting iron blood tests.
authors.affiliation: Department of Medicine, University Hospital, University of Western Ontario, London, Ontario, Canada. padams@uwo.ca
authors.forename: Paul C
authors.initials: PC
authors.lastname: Adams
authors.forename: James C
authors.initials: JC
authors.lastname: Barton
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D005293:Ferritins / Q000097:blood*; D006432:Hemochromatosis / Q000097:blood / Q000175:diagnosis / Q000235:genetics; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006801:Humans; D007501:Iron / Q000378:metabolism; D019189:Iron Metabolism Disorders / Q000097:blood* / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy; D019190:Iron Overload / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D008875:Middle Aged; D009154:Mutation; D018962:Phlebotomy; D014168:Transferrin / Q000378:metabolism*
chemical_list: C103673:HFE protein, human; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins; D014168:Transferrin; D005293:Ferritins; D007501:Iron