Q: My mother is 62 years old, undergoing dialysis. She was taking iron injections and her ferritin level was observed to be 1924 ng/ml where as the reference range is 13-400 ng/ml. Kindly advise the consequences of such a high level?

A:The blood ferritin level reflects the amount of iron storage in the body. A lower level indicates decreased iron resulting in anaemia. This mandates giving iron therapy. However, markedly elevated levels of blood ferritin in dialysis patients (as in the above case) points not only towards the body iron storage level but also, and more importantly is indicative of a chronic infection and inflammation state. The last two conditions are of increased prevalence in dialysis patients often manifested in the form of recurrent episodes of infection and cardiovascular disease resulting in increased morbidity and mortality risks. It is not possible to reduce the markedly elevated ferritin level with any particular medicine. Instead, the appropriate treatment focuses on reducing the risks for recurrent infection and any episodes of cardiovascular disease. Treatment includes adequate dialysis, strict blood pressure and elevated lipid (cholesterol) control, managing the complication of kidney failure including anaemia (treated with erythropoietin hormone injections) and kidney bone disease, routine monitoring of risks for underlying cardiovascular disease and strict dietary compliance. All of these interventions are done under the supervision of one’s nephrologist.