Avaliação do manejo diagnóstico de pacientes com hiperferritinemia no Hospital de Clínicas da UFTM

Abstract

Introduction: Ferritin measurement is a laboratory test widely used in current clinical practice. Known for its ability to indirectly screen iron stores, ferritin changes in various organic conditions, which represents a great challenge in the diagnosis and correct management of patients with this condition. Most cases are related to the absence of iron overload (metabolic syndrome, alcoholism, liver diseases, etc.), while the minority of the cases are due to iron overload (hereditary hemochromatosis, exogenous iron poisoning, etc.). Objectives: The aim of the study is to analyze the reason of referral, investigation and diagnosis of patients with hyperferritinemia evaluated at the hematology outpatient clinic from Hospital das Clínicas of UFTM. Methodology: It is a primary, analytical, observational, retrospective study developed through the evaluation of epidemiological, clinical, laboratory and intervention data. Results: A total of 159 patients were evaluated, most of them white men with low education and from Uberaba, Minas Gerais, Brazil. The primary health care, endocrinology, cardiology and gastroenterology were the most prevalent referral specialties. The pre-outpatient period, prior to the patient’s admission to the outpatient clinic, had higher ferritin levels compared to the outpatient period, after the patients’ admission to the outpatient clinic. Most of the patients evaluated had a transferrin saturation index < 45%. The evaluation of the HFE mutation was performed in 45.2% of the patients, and the percentage of patients studied for HFE mutation without clinical indication was significant. Almost 60% of the patients had access to abdominal ultrasound, and most of those were classified as having moderate hepatic steatosis. Less than 3.0% of the population was able to perform the evaluation of hepatic iron overload, either via MRI or via liver biopsy. The methods and etiological diagnoses provided by the attending medical team of that outpatient clinic were identified, and a comparison was made among the methods and diagnoses identified by the research team of this study after evaluating the data contained in each medical record. Compared to the research group, the assistant medical group tended to make more diagnoses of hereditary hemochromatosis in cases of hyperferritinemia with iron excess, most of them by low potential iron accumulation genotypes. Metabolic syndrome was more prevalent in both groups, with those made by the assistant medical team accounting for 34% of presumed diagnoses of the syndrome. Conclusion: The investigation of hyperferritinemia is a challenge due to its plurality of differential diagnoses, scarcity of clinical guidelines molded to the characteristics of the Brazilian population and its health system peculiarities of the country's health system.