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Hemochromatosis, ferritin shot up, liver function test, ALT normal, protein and albumin normal

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Internal Medicine Specialist
Practicing since : 2007
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I am 50 and 6ft and have been giving blood for 10 years to keep Hemacromotosis successfully under control but earlier this year ferritin shot up to 800 because i think i missed a 3 monthly visit. I have been giving every 2 weeks for a couple of months and just got ferritin down to 350. In last 3 weeks my Liver function test picked up my ALT had gone form normal to 111 and GGT to 100. After no alcohol and good diet since then and I got GGT down to 56 but ALT only got back to 103. Protein and Albumin were both normal. Does ALT typically take longer to go down? Can i read anything into this?
Posted Wed, 2 May 2012 in Liver and Gall Bladder
Answered by Dr. Kiran Kumar 56 minutes later

Thanks for your query.

Hemochromatosis is characterized by accumulation of Iron in body tissues in excess leading to their damage.

This occurs mainly in Liver, Heart, Brain, Skin and Joints.

The best treatment for patients with Hemochromatosis who have normal hemoglobin is Phlebotomy. It has two components.

1. Therapeutic Phlebotomy - This is usually done once every week with close monitoring of Ferritin and Hemoglobin once a month. The target Ferritin is 50 mcgs/ml. Once it reaches this level, maintenance phlebotomies once every 2 - 4 months is initiated.

2. Maintenance Phlebotomy done every 2 - 4 months to keep Ferritin below 50 mcgs/ml.

Your latest ferritin is 350 mcgs/ml and still on the higher side (normal up too 300 in males).

This means that you still have Iron Overload.

In such situations, the liver enzymes abnormalities will persist.

ALT is more sensitive for Liver cell injury than GGT (Which is mainly for the canalicular Injury). Hence the ALT levels will gradually come to normal when the liver cell injury subsides. This will be when the ferritin levels are close to 50 mcgs/ml.

If the ALT levels are still elevated even after maintaining Ferritin to < 50 mcgs/ml, a liver biopsy will be needed to evaluate for Liver Fibrosis.

At this stage, you have to concentrate to bring your ferritin to < 50 by weekly/bi-weekly phlebotomies.

Maintain Hemoglobin between 12 - 13 gms/dl. And then get your ALT levels checked again.

Hope this answers your question.

Please get back if you need any further information.

Thanks and Regards,

Dr Kiran
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