Q: 42 year old male is admitted to ICU with acute on chronic liver failure. Which one test will effectively rule out liver failure secondary to hemochromatosis?

A) Ferritin level
B) Transferrin level
C) Total Bilirubin level
D) Chromium level
E) Serum ETOH  level


Answer: B

Transferrin level less than 45% effectively rule out liver insufficiency secondary to hemochromatosis. Ferritin level (a close call) is usually used later for a follow-up or to complete the comprehensive workup along with gene testing. A transferrin saturation more than 60 percent in males or more than 50 percent in females rule in hemochromatosis in most of the cases.

Other choices (C, D and E) does not rule out hemochromatosis.



Reference:

 Edwards CQ, Kushner JP. Screening for hemochromatosis. N Engl J Med 1993; 328:1616.