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Serum ferritin level in neonatal fulminant liver failure
  1. W S LEE
  2. D A KELLY
  1. Department of Paediatrics, University of Malaya Medical Centre
  2. 59100, Kuala Lumpur, Malaysia
  3. leews{at}
  4. Liver Unit, Birmingham Children's Hospital
  5. Steelhouse Lane, Birmingham B4 6NH, UK

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Editor—Elevated serum ferritin is a non-specific indicator of severe hepatocyte injury.1 ,2 Neonatal haemochromatosis (NH) is an uncommon disorder of neonatal iron storage, which often requires liver transplantation.1 ,3 Serum ferritin levels are considerably elevated in NH,1 ,4 but differentiating NH from other forms of neonatal fulminant hepatic failure (FHF), in which liver transplantation is contraindicated, can be very misleading.1

We reviewed the case records of all neonatal FHF (onset of liver failure less than 28 days of age) seen in this unit from 1990 to 1999 to determine whether other causes of neonatal FHF can lead to an elevated serum ferritin level. Sixteen cases of neonatal FHF were seen, with a median onset of symptoms at 9 days (range 1–18). Eight had NH, confirmed either by histology showing parenchymal haemosiderin deposition in liver or buccal salivary tissue, and/or a positive family history.1 The remaining eight cases had the following causes: mitochondrial disorders (two); galactosaemia,Escherichia coli sepsis,Herpes simplex virus type 1 and 2 hepatitis (one each); undetermined (two). All had raised serum ferritin levels (range 1000–217 000 μg/l). The median serum ferritin level for the patients with NH and the miscellaneous group were 15 000 μg/l (range 1650–217 000) and 2000 μg/l (range 1000–19 530) respectively. There was no significant difference between the mean serum ferritin level of the NH group and that of the miscellaneous group (40 916v 5409 μg/l, p = 0.08).

This observation confirms that the serum ferritin level is raised as the result of severe hepatocellular injury in newborn infants, irrespective of the cause.1 In neonatal liver failure, other diagnostic methods, such as demonstration of extrahepatic iron—for example, in lip salivary glands—or magnetic resonance imaging should be used to confirm or refute the diagnosis of NH.5