High ferritin

Referrers should use this page when referring patients to public adult hepatology outpatient services for high ferritin.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Liver failure (rapid decline in hepatic function in patients) with red flags which include: jaundice ascites hepatic encephalopathy haematemesis (e.g. variceal bleeding) Sepsis in a patient with cirrhosis Spontaneous bacterial peritonitis Severe ascites restricting movement and breathing or causing abdominal pain

Immediate referral
Immediately contact on-call registrar or service to arrange immediate hepatology assessment (seen within 7 days):
Nil

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Ferritin ≥ 500 ug/L or above normal reference range and accompanied by transferrin saturation ≥ 45%

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Relevant history, onset, duration, and severity of symptoms Family history of hereditary haemochromatosis Relevant past medical history (e.g. obesity, type 2 diabetes, metabolic syndrome) Ethnicity Blood transfusions Alcohol consumption Current medication list Any known allergies
Examination	Nil
Investigations	FBC U&E LFT (including AST) HBV and HCV serology HbA1c Fe studies (transferrin saturation and ferritin) Upper abdominal ultrasound (US)

Highly desirable
History	Family history of liver disease or blood disorders
Examination	Height, weight, BMI, and waist circumference
Investigations	Previous LFT CRP Fasting lipids HFE gene studies (only recommended for Caucasian population)

Indicative clinical urgency category
Category 1 Appointment within 30 days	Ferritin level > 1000ug/L with red flags (i.e. evidence of liver decompensation e.g. jaundice, ascites)
Category 2 Appointment within 90 days	Ferritin level > 1000ug/L without red flags (i.e. no evidence of liver decompensation e.g. jaundice, ascites)
Category 3 Appointment within 365 days	Ferritin level ≥ 500ug/L but < 1000ug/L

Indicative clinical urgency category

Category 1

Appointment within 30 days

Ferritin level > 1000ug/L with red flags (i.e. evidence of liver decompensation e.g. jaundice, ascites)

Category 2

Appointment within 90 days

Ferritin level > 1000ug/L without red flags (i.e. no evidence of liver decompensation e.g. jaundice, ascites)

Category 3

Appointment within 365 days

Exclusions
Ferritin level in the normal reference range

Useful information
See Clinician Assist WA: Hereditary Haemochromatosis See Australian Red Cross Lifeblood High Ferritin App Consider elevated ferritin in presence of metabolic dysfunction-associated fatty liver disease (MAFLD) or alcoholic liver disease (ALD) or chronic HCV and HBV infection Consider venesection if serum ferritin >1000ug/L and C282Y homozygous haemochromatosis Monitor Fe studies annually if serum ferritin normal and refer in if ferritin >500ug/L Screen adult family members if genetically confirmed haemochromatosis in index case

Last reviewed: 29-04-2025

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