Q&A: Safe Ferritin levels?

Your questions answered.

Your Questions:
What is in your opinion a safe Ferritin level for a patient with beta Thalassaemia major?

My Answer:
Ferritin levels are the most commonly measured body iron storage measurements. While it may not be the most ideal measure of iron level in the body, it has continued to be a very useful tool because of the relative ease of measuring it.
It has been a regular practice to use changing patterns of Ferritin levels as a measure of the body iron status. It is important to note that one single measurement of Ferritin level, in itelf, is less useful than trends or changes in Ferritin level over a period of time. I think that target Ferritin level for patients with beta thalassaemia major should be based on the benefit that level would bring. That is the positive effect on the prognosis in terms of reduction in risk of complications and improvement in survival.

• Ferritin levels above 2000 micrograms/Litre for long periods of time are known to increase the risk of multi-organ damage as a complication of iron overloading. Although used in some places, target Ferritin levels of around 2500 micrograms/Litre are not ideal because of this reason.
• Ferritin levels between a 1000 and 2000 micrograms/Litre are a bit better. However, there still is an increased risk of organ damage if Ferritin levels remain above a 1000 micrograms/Litre for a long period of time.
• Ferritin levels below a 1000 are, based on current data, better targets because the risk of organ damage are so significantly reduced that it is very close to no additional risk.
• The high end of "normal" Ferritin level for the general population is around 150-300 micrograms/Litre dependent on age and gender. It is quite possible to achieve this level. There are several people who have been able to safely reduce their Ferritin levels to this level and maintain it over long periods of time. However, currently there is a bit of concern whether achieving such low Ferritin levels is of significant extra benefit than having a level of less than a 1000 micrograms/Litre. There have been reports of increasing incidence of Desferal side effects in individual who have very low Ferritin levels. This could perhaps be reduced by using lower doses.

My current practice is to encourage patients with beta thalassaemia major to first try to get their Ferritin levels to below 2000 micrograms/Litre. Those who can achieve this will be encouraged to lower it furthur to less than a 1000 micrograms/Litre. And once that is possible have it reduced and maintained around 500 micrograms/Litre.

I think it is very important to communicate this entire plan to the patient at the very beginning, so that they can themselves monitor their progress and know that each of the set targets are steps in achieving the 500 mark.

Having said that, from a prognosis point of view maintaining Ferritin levels anywhere below a 1000 micrograms/Litre is considered a good target. And the 500 micrograms/Litre is no universally accepted as the best Ferritin level.

A note to readers:
Reductions in Ferritin levels can take time. It requires a lot of effort from the patient as well as their families. It can be achieved with Desferal safely. I would like to remind readers that it is absolutely vital that you discuss with your treating doctor regarding setting targets and planning for lowering your Ferritin levels, especially with respect to your Desferal dosage. No change to treatment should be brought about without consulting your doctor.