Hyperferritinaemia in Pregnancy

Recently, one of the authors submitted in article in SciFed Obstetrics & Women Healthcare Journal.

Elevated ferritin levels in pregnancy are associated with adverse maternal and fetal outcomes. We present a thirty-six-year-old woman in her eighth pregnancy who developed severe hyperferritinaemia at 32 weeks gestation. She was anaemic with abnormal liver function tests, but remained asymptomatic and clinically well. Despite extensive investigations and Obstetric, Haematology, Gastroenterology and Anaesthetic input, a conclusive diagnosis was not made. Following a spontaneous vaginal delivery at 35 weeks gestation, serology results deteriorated again, but improved over the subsequent four months. The most likely diagnosis is pregnancy-induced haemolysis and monitoring will be essential at an early gestation in future pregnancies.  Clinicians should consider this condition in similar situations when other causes have been excluded. This case highlights the importance of undertaking basic investigations when complex patients are managed by numerous specialities. Rare presentations or patients without a confirmed diagnosis should be treated under consultant supervision with a multi-disciplinary team approach.

Iron is stored intracellularly in the protein ferritin. Reduced levels indicate iron deficiency anaemia and elevated levels often occur due to iron overload. This accumulation may be from excessive dietary absorption or following repeated blood transfusions, intravenous iron administration and sustained iron supplementation (secondary iron overload). Primary iron overload results from the autosomal recessive condition, Hereditary Haemochromatosis.Ferritin is also an acute phase protein and can be raised in liver disease, renal disease, metabolic syndrome, malignancy and infection. Hyperferritinaemia can be managed with venesection, blood donation and iron chelators. The underlying condition should be treated if due to a reactive cause.