Visual summary of managing raised ferritin guidance, overlaid with picture of Dr Stuart Stewart

New approach to managing iron overload

A new approach could improve the way GPs (and generalists) manage patients with iron overload.

Raised levels of ferritin – an iron storage protein – can be associated with several serious underlying conditions. GPs frequently ask for a ferritin test when investigating anaemia or associated symptoms such as fatigue, restless legs, or hair loss, as well as when a patient has an abnormal liver blood result.

But there are other possible causes for raised ferritin so now researchers have described a systematic approach for assessing patients with iron overload in primary care.

Lead researcher Dr Stuart Stewart is a GP, clinical research fellow and research ambassador for Rochdale Care Organisation, part of Northern Care Alliance NHS Foundation Trust.

3-step algorithm

He said: “We know from the literature and experience of GPs that many clinicians don’t know how to manage a patient with a raised ferritin.

“We’ve now devised a systematic three-step algorithm for this, building on the 2022 European Association for the Study of the Liver’s clinical practice guidelines for haemochromatosis – an inherited condition where iron levels in the body slowly build up over many years.

“It begins with the initial clinical assessment, looking closely at the patient and factors that might be involved in their symptoms. That’s followed by an assessment for iron overload – most patients with a raised ferritin won’t have iron overload and there are a number of other potential causes. The final part of the algorithm focuses on assessing for serious underlying disease.

“Those that do have iron overload might have haemochromatosis, which can damage many parts of the body such as the liver, joints, pancreas and heart (as well as other tissues). While patients with iron overload may need referral to a specialist, the paper outlines a multisystem assessment of iron overload that can be undertaken by GPs in primary care to facilitate assessment of complications and onward referral.”

The three-step algorithm and multisystem assessment has been published in The BMJ

Skip to content