Elevated serum ferritin

While there is interest in iron reduction therapy for cancer risk reduction,3 improvement of insulin sensitivity in metabolic syndrome4 and management of fatty liver disease not responding to lifestyle changes,5 the Australian Red Cross Blood Service Therapeutic Venesection program is currently restricted to patients meeting the criteria listed in Table 1, and who also meet the general eligibility criteria for volunteer blood donation. Patients meeting therapeutic venesection criteria with contraindications to volunteer blood donation (eg. comorbid angina, hepatitis C, cerebrovascular disease) need to be referred elsewhere for therapeutic venesection. Options include private pathology providers, public hospitals, haematologists and some GPs. In the absence of contraindications, patients with elevated SF who do not meet eligibility criteria for therapeutic venesection may become volunteer wholeblood donors every 12 weeks. Potential harms of frequent venesection therapy for a person without true iron overload include development of iron deficiency anaemia, reinforcement of a suboptimal management strategy for a biochemical abnormality, perpetuation of the myth that a genetic condition affecting family members exists, and the general venesection risks of venous scarring, phlebitis and vasovagal episodes. The Australian Red Cross Blood Service has experienced a growing number of referrals from general practitioners for therapeutic venesection for patients with elevated serum ferritin (SF) who do not meet the eligibility criteria of two HFE mutations or documented iron overload. Thirtysix percent of referrals to the Australian Red Cross Blood Service Therapeutic Venesection program in an 8 month period in 2011 were for patients with elevated SF and an HFE genotype not associated with iron overload.1 Venesection therapy, while the mainstay of treatment for iron overload due to hereditary haemochromatosis (HH), does not address the underlying reasons for elevated SF in patients without true iron overload.2 Background Elevated serum ferritin is commonly encountered in general practice. Ninety percent of elevated serum ferritin is due to noniron overload conditions, where venesection therapy is not the treatment of choice.