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High ferritin level, enlarged spleen, low platelets. What do you think?

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I have a ferritan level of 935 - platelets are at 135 and during my exam my hemotologist said that I have a slightly enlarged spleen. CBC, liver functions, kidney function, and iron levels are all normal, no physical symptoms of anything - took the hemocromotosis genetic test and it came back negative. My grandfather died of cirrohis of the liver in the 1950's which they attributed to gold shots - he was a non drinker. Hemotologist suggested an ultrasound and a liver biopsy which I will be doing just to be safe. He also thinks that hemochromotosis may be present even though I dont have a genetic marker and my iron is normal. I do have CHD and a low HDL. Recently read that Ferritan levels can be raised because of heart disease. Doctor feels that spleen is slightly enlarged (based on his physical exam) because of Ferritan which now explains the slightly lower platelets. Had slightly low platelets and ferritan for several years but internist did not think it was anything because other tests were normal - decided to initiate hemotologist visit on my own. What do you think? Can this be indicative of something very serious based on what I described?
Can someone have high ferritan and nothing else? In your opinion what are the chances based on what I described that I do have liver damage or that I have another serious illness such as lymphoma, hodgkins.
Just did more reading and discovered that one of the symptoms of cirrohis is increased spleen size - again my liver functions are normal (my ALT is 56 on recent test but its generally around 37). I also read that Ferritan would have to be consistantly over 1,000 to do serious damage.

Could this be possible with really no other symptoms and normal blood work?
Just got my new blood results as of 1/10/12
Ferritan dropped to 626
ALT declined to 46
platelets at 136
other results are normal (CBC, kidney,liver functions etc)
Thank you
Posted Sun, 6 May 2012 in Blood Disorders
Answered by Dr. Indranil Ghosh 34 hours later

Thank you for posting the query.

You mentioned that you have a slightly high ferritin level with a slightly low platelet count for years. It is unlikely for a serious disorder to be at a constant level for such a long time. And now your ferritin level seems to be dropping which is a very good sign.

Your liver function tests and iron levels are normal. Your genetic test for hemochromatosis is negative. Hence I feel hemochromatosis is not the diagnosis here. Cirrhosis from other reason is also not likely.

Ferritin is a marker of chronic inflammation. Though you have mentioned only cardiovascular disease as any chronic disorder you have, even it can sometimes lead to elevated inflammatory markers like CRP (C - reactive protein) and ferritin. I feel it is likely to be due to the same thing.

Aspirin can lead to a low platelet count. Most likely it is the case in you. But you should not stop aspirin for a platelet count of 135,000.

As for malignant disorders (lymphoma), I don't see a possibility as you have been stable problems for years. The spleen needs to be evaluated by an USG (ultrasound abdomen).

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Above answer was peer-reviewed by
Follow-up: High ferritin level, enlarged spleen, low platelets. What do you think? 2 days later
Thank you Doctor
I just got back the results of my ultrasound
Everything was normal
What they said of the liver was as follows:
The liver demonstrates diffuse increased echogenicity. The appearance suggests fatty infiltration versus hepatocellular disease. No focal hepatic lesion is identified. There is no evidence of intra or extrahepatic biliary ductal dilation. The common duct measures 4.0 mm.
Spleen was normal.

The doctor recommends a liver biopsy just to be sure. I have one scheduled later this month.

I was taking a multivitamin from GNC which had iron, my doctor recommended I stop taking it for now. A week later I retook the ferritan test and it dropped to 626 with the ALT dropping 10 points. Do you think this could be the problem? I've been taking the vitamin for years.

Answered by Dr. Indranil Ghosh 8 hours later
Thanks for writing back.

It is reassuring to know that the liver ultrasound was fine. I think it is more likely to be fatty infiltration than anything else. You can certainly get the liver biopsy done, but in all probability it will be normal or only fatty liver, which is a benign problem.

Oral iron supplements, if taken for a long time, can lead to elevated ferritin but unlikely to cause elevated liver enzymes. However, your ALT (Alanine transaminase) was only borderline high, which may not be significant at all.

Overall, considering all the information shared by you, I don't think you have any serious underlying disease to worry about at this point.

Hope I have answered your query. Please accept my answer in case you do not have further queries.
Above answer was peer-reviewed by
Follow-up: High ferritin level, enlarged spleen, low platelets. What do you think? 8 days later

Given the results of the ultrasound, do you think a liver biopsy is necessary?

I was thinking of having my ferritan levels measured one more time (it's been almost a month since I've been off the multivitamins) to see if there has been a further decline in the levels. Given they have declined over 300 pts in 2 weeks after stopping the vitamins-I'm hopeful for a further drop.

I know there is some minor risk associated with the biopsy and I feel that given the ultrasound results is it necessary at this point? What do you think?

Thank you
Answered by Dr. Indranil Ghosh 28 minutes later
Hi again,

I feel that the biopsy is not really necessary at this point. We can always follow-up and do it later if the enzymes increase or ultrasound shows progression.

You can go ahead with the repeat ferritin level, if it shows further decline then it will be extremely reassuring.

Best wishes,
Above answer was peer-reviewed by
Follow-up: High ferritin level, enlarged spleen, low platelets. What do you think? 5 hours later
Thank you Doctor

I think that is what I am going to do. I will repeat the ferritan test over the next few days and then take another ultrasound over the next six months.

Answered by Dr. Indranil Ghosh 7 hours later
Hello again.

Yes, I agree that it would be the appropriate decision in this situation.

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Wish you good health.

Above answer was peer-reviewed by
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