Date: [DATE]
Patient: [Patient Name]
MRN: [Medical Record Number]
Subjective:
Document the reason for this visit. Is this a workup for incidentally identified elevated ferritin, or are there concerning symptoms?
Inquire about current symptoms that might be related to iron overload, such as:
Fatigue
Joint pain
Abdominal pain
Weakness
Ask about the patient’s medical history, including:
Diabetes mellitus
Metabolic syndrome
Non-alcoholic fatty liver disease (NAFLD)
Excessive alcohol intake
History of blood transfusions
Objective:
Vital Signs: Include blood pressure, weight (if appropriate).
Physical Exam:
Look for signs of chronic liver disease (jaundice, hepatomegaly, spider angiomata).
Assess for joint tenderness or swelling.
Laboratory:
Mention ferritin level (reference range varies by lab).
If not already checked, consider tests to evaluate for underlying causes of elevated ferritin:
Complete blood count (CBC) to assess for anemia or iron deficiency.
Liver function tests (LFTs) to evaluate for liver disease.
Transferrin saturation (iron saturation) to assess iron stores.
Fasting blood sugar or HbA1c to check for diabetes.
Assessment:
Dysmetabolic hyperferritinemia based on elevated ferritin levels in the setting of metabolic syndrome or other conditions associated with insulin resistance.
Consider differential diagnoses for elevated ferritin, including iron deficiency anemia, chronic inflammatory conditions, and occult blood loss.
Plan:
Address Underlying Conditions:
Management of diabetes or prediabetes with lifestyle modifications and medications.
Weight loss for patients with overweight or obesity.
Treatment of NAFLD if present.
Reduce alcohol intake if excessive.
Iron Depletion (if transferrin saturation is low):
Consider blood donation if appropriate and tolerated by the patient.
Discuss potential risks and benefits of phlebotomy with the patient.
Iron Chelation (if transferrin saturation is high):
In severe cases with evidence of organ damage, discuss chelation therapy with a hematologist to remove excess iron from the body.
Laboratory Follow-up:
Repeat ferritin levels to monitor response to treatment (frequency depends on initial level and treatment plan).
Consider monitoring LFTs and CBC as needed depending on the underlying condition.
Follow-up:
Schedule regular follow-up visits to monitor ferritin levels, blood pressure, and other laboratory tests as indicated.
Address lifestyle modifications for long-term management of underlying conditions contributing to dysmetabolic hyperferritinemia.
Consider referral to a hepatologist or metabolic specialist for complex cases.
Note: This is a template and should be adapted to the specific patient encounter. Document all relevant details regarding symptoms, risk factors, laboratory findings, assessment, and treatment plan. The focus should be on identifying and managing the underlying cause of iron overload.