Clinical Mysteries • Haematology
The Anaemia With a High Ferritin
The presentation
Fatigue and low haemoglobin suggested iron deficiency, but ferritin was unexpectedly high.
The first explanation was plausible, but the pattern did not fully fit. A deliberate second look focused on physiology, medication/exposure history, serial observations and the clue that the initial diagnosis could not explain.
The turn
Low transferrin saturation with inflammatory markers explained the misleading ferritin.
Diagnosis
Anaemia of inflammation
Why this case matters
Ferritin is an iron marker and an acute-phase reactant.
Take-home message: When the clinical course contradicts the working diagnosis, stop escalating the same treatment and rebuild the problem from first principles.