Normal serum ferritin levels in a patient with HEMPAS syndrome and iron overload

Serum ferritin levels in a patient with HEMPAS syndrome (hereditary erythroblastic multinuclearity associated with positive acidified serum test) were correlated with body iron stores directly measured on spleen and liver biopsy specimens as well as by quantitative serial phlebotomy. Normal serum ferritin concentrations were found in the presence of a moderate excess in iron stores (approximately 6-12 times normal). They temporarily increased after transfusion and splenectomy with a prompt return to the normal range. As repeated phlebotomies over a period of nine months depleted the excess iron stores, the serum ferritin ultimately decreased to a subnormal concentration. The serum ferritin concentration was not a reliable index of increased body iron stores in this iron overloaded patient, but did reflect their depletion by serial phlebotomy.