How to reduce my serum ferritin level?

Question

Hi doctor,

My ferritin level is 1500, and I want to bring it down to 150. How much will one DFO IV session or each Exjade pill reduce the ferritin level on average?

I am a healthy individual, and I do not have HIV, HCC, or any other disease.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Your serum ferritin is high, so the cause should be found out first. It can be hemochromatosis, in which excess iron is stored in the bone marrow.

Deferoxamine is used for increased iron storage in thalassemia patients. For high ferritin, phlebotomy is also another mode of treatment. Hence, consult a nearby physician or hematologist for examination and discuss the treatment plan.

I hope this will help you.

Kindly revert in case of further queries.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

You have an excess iron load. The causes can be thalassemia, sideroblastic anemia, liver problems, transfusion-induced iron overload, etc.

Iron chelator therapy is usually given in thalassemia patients, where blood transfusion is also needed simultaneously. So phlebotomy is not usually adopted in that patient. An iron chelator is mainly of two types:

Deferoxamine, which is available as a 500 mg vial. It can be reconstituted with sterile water and the recommended dose is 9 to 18 mg/lb/day. It is given as a slow subcutaneous infusion over 8 to 10 hour for five days in a week.

Deferiprone, which is available as oral preparation as well.

As per statistical data, 100 mg Desferal (Deferoxamine) can chelate around 7 to 8 mg of ferric iron. This iron chelator has side effects like allergy, agranulocytosis, retina affection, etc. Hence, it is not given unless indicated or is given under strict monitoring.

Moreover, an iron chelator will not chelate all types of iron. If no secondary cause of iron overload is present, then a congenital mutation or a transferrinemia might be the cause.

Phlebotomy of 500 ml of blood can chelate around 200 mg of iron, once or twice per week is the treatment given until serum ferritin is less than 50 mg/L. And maintenance phlebotomy is done for a few months. Hence, consult a hematologist for examination and discuss all this. Vitamin C helps in more iron absorption, so citrus fruits can be restricted.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

I appreciate your awareness regarding your condition.

1. First of all, do not worry. When you consult a nearby hematologist, he will examine you and will suggest necessary investigations for the cause of hemochromatosis. If needed, the hematologist will advise you to test for genetic mutation study by PCR (polymerase chain reaction) also.

2. Usually, phlebotomy will be a good option for you if you are not a thalassemia patient. Phlebotomy removes the red blood cell with attached iron in them. Hence, it is much more effective than an iron chelator. Around 500 ml blood removal will clear 200 to 250 mg of iron. Phlebotomy is done when your ferritin levels reach below 50 mg/L or below 25 ng/dl.

3. Iron chelator as a subcutaneous infusion or other parenteral route is more effective as compared to oral route. All parenteral routes have almost the same effectiveness in chelating iron. No further conclusive statistical data is available as per my knowledge.

So consult a hematologist, discuss all this. After serum ferritin comes within range, your doctor might put you on a maintenance phlebotomy as needed.

Take care.

Hope this will help you.

Wish you good health.