Subject(s)
Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute , Lymphoma, Large B-Cell, Diffuse , Neoplasms, Second Primary , Adult , Allografts , Child , Humans , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/pathology , Leukemia, Myeloid, Acute/therapy , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/etiology , Lymphoma, Large B-Cell, Diffuse/genetics , Lymphoma, Large B-Cell, Diffuse/pathology , Male , Neoplasms, Second Primary/drug therapy , Neoplasms, Second Primary/etiology , Neoplasms, Second Primary/genetics , Neoplasms, Second Primary/pathologyABSTRACT
Serum ferritin level is one of the most commonly requested investigations in both primary and secondary care. Whilst low serum ferritin levels invariably indicate reduced iron stores, raised serum ferritin levels can be due to multiple different aetiologies, including iron overload, inflammation, liver or renal disease, malignancy, and the recently described metabolic syndrome. A key test in the further investigation of an unexpected raised serum ferritin is the serum transferrin saturation. This guideline reviews the investigation and management of a raised serum ferritin level. The investigation and management of genetic haemochromatosis is not dealt with however and is the subject of a separate guideline.
Subject(s)
Ferritins/blood , Iron Overload , Kidney Diseases , Liver Diseases , Metabolic Syndrome , Neoplasm Proteins/blood , Neoplasms , Humans , Inflammation/blood , Inflammation/therapy , Iron Overload/blood , Iron Overload/therapy , Kidney Diseases/blood , Kidney Diseases/therapy , Liver Diseases/blood , Liver Diseases/therapy , Metabolic Syndrome/blood , Metabolic Syndrome/therapy , Neoplasms/blood , Neoplasms/therapy , Practice Guidelines as TopicABSTRACT
Anaemia of chronic disease is the second most common form of anaemia worldwide, and is seen in a variety of inflammatory, infective and malignant diseases. Functional iron deficiency is fundamental to the pathogenesis of the anaemia, and the polypeptide, hepcidin, plays a key role. Diagnosis may be difficult, but new automated red cell indices, algorithms for detection of functional iron deficiency, and assays for hepcidin levels are being developed. Management of the causative disease process will usually improve haemoglobin levels, but where this is not possible, erythropoietic stimulating agents are often used, although there are still concerns about potential adverse effects, especially thromboembolism. There is increasing evidence that supplemental iron given parenterally can safely overcome the functional iron deficiency. Inhibitors of hepcidin, and various inflammatory modulators show promise for the future.
