Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Appropriate management and investigations for a patient with a ferritin level of 1800 µg/L:
- A ferritin level of 1800 µg/L is significantly elevated and suggests iron overload rather than iron deficiency; therefore, iron supplementation is contraindicated and should be avoided.
- Investigations should focus on confirming iron overload and identifying its cause, including detailed iron studies (serum iron, transferrin saturation), liver function tests, and assessment for possible haematological disorders or malignancy recurrence.
- Given the high ferritin, consider referral to haematology for specialist evaluation, which may include bone marrow examination if indicated.
- Exclude active malignancy or metastasis as ferritin is an acute phase reactant and can be elevated in inflammatory or malignant conditions.
- Monitor iron status regularly to prevent complications of iron overload; if clinically significant iron overload is confirmed, consider iron chelation therapy under specialist guidance.
- Do not initiate or continue iron therapy in this context; treatment should be tailored based on specialist advice.
Summary: Confirm iron overload diagnosis, investigate underlying causes including malignancy and haematological disease, refer to haematology, avoid iron supplementation, and consider iron chelation if indicated.
References: This approach aligns with guidance on iron overload management and specialist referral for haematological investigations when iron overload is suspected 1,9.