Dealing with abnormal iron serum tests, the first step is to check
the transferrin saturation coefficient. If it's greater than 45%
a genetic test is indicated. A positive result leads to the diagnosis
of genetic hemochromatosis. A liver biopsy is only indicated if
there is some arguments in favor of associated fibrosis. This can
only be seen when one of following items is true:
The presence of a fibrosis increases potential risks.
- hyperferritinemia greater than 1000 UI,
- hepatic cytolyse.
In other circunstances (transferrin saturation coefficient below
45% or negative genetic test), dealing with a hyperferritinemia,
the first step is to eliminate an increase of ferritinemia which
is not related to an iron overload (acute inflammation, cytolyse,
cirrhosis...). Then there is (roughly) 3 possibilities : anemia
with ineffective erythropoiesis, hepatitis (and a liver biopsy is
more suitable than a MR study) or dysmetabolic hepatosiderosis (and
a MR study is then preferable).
Details on MR protocol...