High Ferritin, LDH & ALT

[Threelions]

Hi Friends,

I’m ETJ2+

My last bloods showed

Ferritin- 490 (says max normal is 200)

LDH- 268 (says max normal is 220)

ALT- 99 (says max normal is 55)

I was just after increasing my knowledge of the above blood readings and their relationship with ET/MPN

I’ll speak to Guys in due course at my next appt. but rather than googling I wondered if anyone could explain further what importance Ferritin, LDH & ALT readings’ are what they indicate in blood tests.

Many thanks in advance.

Mark x

[hunter5582]

Elevated LDH is not uncommon with MPNs. The short answer is that when you have hypercellular activity in the marrow, you get more cellular turnover and you get elevated LDH. There is more to this issue that you can discuss with your MPN care team.

ALT is one of the liver function tests that are routinely done. There can be a number of reasons why ALT, AST or other LFTs are elevated. It is fairly common when taking interferons and other medications.

The elevated ferritin does need follow up. There can be a number of reasons for this elevated iron storage number. It needs to be interpreted in the context of the other numbers in a full iron panel.

• Serum iron. This test measures the amount of iron in your blood.

• Serum ferritin. This test measures how much iron is stored in your body. When your iron level is low, your body will pull iron out of “storage” to use.

• Total iron-binding capacity (TIBC). This test tells how much transferrin (a protein) is free to carry iron through your blood. If your TIBC level is high, it means more transferrin is free because you have low iron.

• Unsaturated iron-binding capacity (UIBC). This test measures how much transferrin isn’t attached to iron.

• Transferrin saturation. This test measures the percentage of transferrin that is attached to iron.

webmd.com/a-to-z-guides/iro...

Reference Ranges. Note that may vary by lab.

Ferritin 15.0 - 200.0 ng/mL

Iron 50.0 - 212.0 mcg/dL

Iron Binding Capacity 250.0 - 425.0 ug/dL

Iron, % saturation 20.0 - 50.0 %

Iron Binding Capacity 250.0 - 425.0 mcg/dL

Iron Binding Capacity (unsaturated) 155.0 - 355.0

This is an issue to review with your MPN care team. Please do letus know what you learn and how you get on.

[Threelions in reply to hunter5582]

Thanks, as always, for your reply Hunter. Your contributions here are fantastic & it’s always good to add to our knowledge.

Since posting my caeruloplasmin result came into my file.That showed as low.

I’ll e mail Guys & get their thoughts on it.

I’ll also be sure to let you know what they say.

Thanks ever so much again for sharing your knowledge.👍

Mark

[ainslie]

the LDH is quite good for MPN, ALT may be transitory , can be due to many unimportant things but best monitor and report if stays up, ferritin needs investigating, maybe ask Guys sooner than later

[Alexbits]

I have had high ferritin when my interferon (Pegasys) dose was higher. See healthunlocked.com/mpnvoice...

[fernie]

Hi, I have high ferritin and liver tests go up and down regularly too Alt. GGT etc. I'm on Pegasys, low dose for three years now. Currently 45mg every two weeks. Im a carrier of haemochromatosis in Type 1 and type 3 and a few other misc. iron genes. I am also double JAK2 46/1 haplotype SNP rs10974944 (GG) plus I'm JAK2V617+ at low allele burden 7%. Thery diagnosed me with PV, in 2018 but now want to change back to ET because my allele burden it so low. PV is usually over 50%. After a long while my haem. is finally looking at this. I'm getting brain problems too when ferritin is high. Waiting on a MRI. This has happened before. I've formed lesions prior to JAK2+ diagnosis when iron labs high. Usually lose some physical function, then it comes right in a month or so. Was diagnosed with MS in 2018, but they have now changed their minds on that too. Anyone else?

[EPguy in reply to fernie]

to fernie

Allele burden is not part of standard diagnostics to select ET vs PV. Table 1 in this reference shows criteria for MPNs, presence of Jak2 matters, but how much does not. Your reduction is common, and great, with IFN but it would not by itself change it to ET. There must be something else that changed. I'm interested in this because my Dx is PV but my various test results look more like ET.

ncbi.nlm.nih.gov/pmc/articl...