Case 3: 52-year old female with high ferritin levels
Serum ferritin is the most useful estimate of body iron stores.(1) However, serum ferritin alone may not present a true picture of iron status since it is an acute-phase protein and, therefore, can be elevated by concomitant inflammatory conditions, infections, malignancy, hyperthyroidism, liver disease and heavy alcohol intake.(1-3) Therefore, interpretation of ferritin levels is not always straightforward, and requires an appreciation of the physiology of iron metabolism and the use of other markers to diagnose accurately the form of iron deficiency that is present.
This interactive case study was developed with the expertise and support of Professor Jolanta Małyszko (Professor of Nephrology, Medical University, Bialystok, Poland) and enables you to apply the new knowledge you have gained in a practical way that will help you to improve the outcomes of your patients.
In this case, a 52-year old woman who received a kidney transplant presents with endocarditis owing to S. aureus infection from a tunnelled dialysis catheter. Follow the progress of the patient, decide how you would assess her laboratory work up and choose the next course of action, and compare your decisions with those of Professor Małyszko. Key learning points throughout the case study will offer explanations regarding the correct strategy.
- Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet 2007;370:511–520.
- Macdougall IC. Monitoring of iron status and iron supplementation in patients treated with erythropoietin. Curr Opin Nephrol Hypertens 1994;3:620–625.
- Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol 2006;1 Suppl 1:S4–8.