خانمی مسن با سابقه کانسر پستان که درمان شده است فریتین ۱۸۰۰ دارد چه باید کرد؟

Appropriate management for an elderly woman with a history of treated breast cancer and a ferritin level of 1800:

• A ferritin level of 1800 µg/L is markedly elevated and suggests iron overload rather than iron deficiency. This requires further evaluation to determine the cause of iron overload, which may include secondary causes such as repeated blood transfusions, chronic liver disease, or a primary haematological disorder.
• Given the history of breast cancer, it is important to exclude active malignancy or metastasis as a cause of elevated ferritin, as ferritin can be an acute phase reactant.
• Referral to haematology is appropriate for further assessment, including detailed iron studies, liver function tests, and possibly bone marrow examination if indicated, to investigate for conditions such as haemochromatosis or myeloproliferative disorders.
• Management may include monitoring iron levels regularly and considering iron chelation therapy (e.g., desferrioxamine) if iron overload is confirmed and clinically significant.
• There is no indication to treat with iron supplementation in this context; iron replacement is contraindicated in iron overload states.

In summary, the key steps are to confirm the diagnosis of iron overload, investigate underlying causes including malignancy recurrence or haematological disease, and refer to haematology for specialist management including consideration of iron chelation therapy if needed.

References: This approach aligns with guidance on iron overload management and the use of desferrioxamine mesilate for iron overload ², and the need for specialist referral for haematological investigations when iron overload is suspected ⁹. The history of breast cancer necessitates consideration of malignancy-related causes ¹³.

Key References

• Ascorbic acid SmPC
• Desferrioxamine mesilate SmPC
• Sodium feredetate SmPC
• Paclitaxel [Specialist drug] SmPC
• Trastuzumab [Specialist drug] SmPC
• Ferric carboxymaltose SmPC
• Ferrous fumarate SmPC
• CKS - Iron deficiency anaemia
• CKS - Anaemia - iron deficiency
• CKS - Erythrocytosis/polycythaemia
• CKS - Polycythaemia/erythrocytosis
• CG164 - Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer
• CG81 - Advanced breast cancer: diagnosis and treatment
• NG203 - Chronic kidney disease: assessment and management
• NG101 - Early and locally advanced breast cancer: diagnosis and management