Haematology

Question 1

What is the first step if raised ferritin?

Answer 1

Check Iron and CRP for transferrin saturation

Question 2

What is the cut off for transferrin saturation for a raised ferritin?

Answer 2

45%

Question 3

What do you do in a raised ferritin with a raised transferrin saturation of >45%

Answer 3

Organise LFTs and FBC, try HFE genotype. Also check lifestyle advice and alcohol consumptions/physical exercise

Question 4

What do you do in a raised ferritin with a raised transferrin saturation of >45% and normal LFTs

Answer 4

Refer to Haematology and organise an US Abdo whilst waiting

Question 5

What do you do in a raised ferritin with a raised transferrin saturation of >45% and abnormal LFTs

Answer 5

Refer to Hepatology and organise US Abdo

Question 6

What do you do in a raised ferritin with a low transferrin saturation of <45%?

Answer 6

Consider the following causes with investigation:
Infection/inflammation, alcohol, diabetes, obesity/BMI, Haematology disease, renal disease, hereditary/hyperferritinaemia cataract syndrome, malignancy, viral hepatitis

Question 7

What do you do in a raised ferritin with a low transferrin saturation of <45% and you have considered causes?

Answer 7

Check ferritin

Question 8

What do you do in a raised ferritin with a low transferrin saturation of <45% and you have considered causes, and ferritin is low <450mcg

Answer 8

After 12 weeks check FBC, Ferritin and Transferrin Saturation

Question 9

What do you do in a raised ferritin with a low transferrin saturation of <45% and you have considered causes, and ferritin is low <450mcg, and bloods are normal

Answer 9

Normal

Question 10

What do you do in a raised ferritin with a low transferrin saturation of <45% and you have considered causes, and ferritin is low <450mcg, and ferritin is high >800

Answer 10

Refer to Hepatology. May need an endoscopy. Attach all blood and ultrasound results

Question 11

What do you do in a raised ferritin with a low transferrin saturation of <45% and you have considered causes, and ferritin is high >450mcg.

Answer 11

After 4 weeks, FBC, Ferritin, Transferrin Saturation, HbA1c, TFTs and US Liver. If Ferritin High >800, Refer to Hepatology.

Question 12

What do you do in a raised ferritin with a low transferrin saturation of <45% and you have considered causes, and ferritin is high >450mcg. Investigations demonstrate metabolic syndrome with fatty liver/high alcohol and ferritin <800.

Answer 12

Fatty liver or alcohol pathway

Question 13

If Ferritin 300-800 and no cause found

Answer 13

Optimise lifestyle, stopping alcohol, weight loss, lowering lipids, glucose control etc. reactive causes of raised serum ferritin levels, including malignancy, inflammatory disorder, renal failure, liver disease and metabolic syndrome.