373 Ferritin & 61% Transferring Saturation: Iron overload/hemochromatosis vs fatty liver, or worse?

[concerned_ibs_sufferer]

34 yr old Asian male, doing followup labs monitoring lesions suspected to be atypical hemangioma
Lab data below:
Ferritin (22-322 ng/ml std range):  373 ng/ml (5/2011)

Transferrin saturation  (15-60% std range):  61% (5/2011)
Iron (41-196ug/L): 166
IBC unsaturated (100-315 ug/L): 104
TIBC (236-404ug/L): 270

ALT (<36 U/L):  41 (5/2011), 47 (12/2010), 48 (9/2010), 29 (3/2010) ;  
AST (10-40 U/L):   24 (5/2011), 26 (12/2010), 22 (9/2010), 18 (3/2010)

All other labs normal.  Note 25 mg/day Seroquel was stopped ~7 weeks before 5/2011 lab test to see if it was causing elevated ALT

Can a "fasting" elevated ferritin, elevated transferrin saturation &elevated ALT be attributed to fatty liver vs iron overload?  5/2011 set of liver lab tests were done in preparation for follow up CT scan in June to monitor suspected atypical hemangioma lesion

GI Dr thinks elevated labs may be related to fatty liver (which was previously seen around liver lesions in a prior ultrasound).  I know that NAFLD may be associated with elevated ferritin but is that also true of elevated transferrin saturation %? GI Dr does not suspect iron overload as Ferritin <1000 ng/ml.  Can elevated transferring sat% & ferritin, & elevated ALT all be due to fatty liver?

Don't 61% transferring saturation% & 373 ng/ml ferritin give strong predictive value for iron overload/hemochromatosis? Is a gene test irrelevant for asian patient?  How does one differentiate between fatty liver & hemochromatosis?

I'll also be having 3rd CT on suspected atypical hemangioma lesions in June (9mo interval); no growth so far at 1wk, 3mo intervals.  Can one have both fatty liver AND hemochromatosis, or is it more likely elevated labs are all due to fatty liver, or worse liver disease/lesion?

CT lesion history here:
http://www.medhelp.org/posts/Liver-Transplant/liver-cancer-vs-atypical-hemangioma---proper-long-term-diagnosis-course-of-action/show/1450475?personal_page_id=1799698#post_6603410

[concerned_ibs_sufferer]

34 yr old Asian male, with fatigue symptoms, depression/anxiety, IBS, memory issues/trouble concentrating

Lab data below:
Ferritin (22-322 ng/ml std range):  373 ng/ml (5/2011)

Transferrin saturation  (15-60% std range):  61% (5/2011)
Iron (41-196ug/L): 166
IBC unsaturated (100-315 ug/L): 104
TIBC (236-404ug/L): 270

ALT (<36 U/L):  41 (5/2011), 47 (12/2010), 48 (9/2010), 29 (3/2010) ;  
AST (10-40 U/L):   24 (5/2011), 26 (12/2010), 22 (9/2010), 18 (3/2010)

I spoke with GI doctor again.  He said I could do a HFE gene test next time I need bloodwork; however, he seriously doubts that I have hemochromatosis.  Given that I am asian, I'm guessing I'll be negative on HFE test, but couldn't I have non-HFE Hemochromatosis?

I guess my concern is my one fasting test result of 61% transferrin sat & 373 ferritin.

All the research papers suggest 45% transferring sat% & 250 ferritin cutoff for screening hemochromatosis, or a more stringent fasting 55% transferring sat% & 350 ferritin cutoff for diagnosing hemochromatosis.  

My GI doctor thought it very unlikely that I have hemochromatosis and he was not concerned at all about elevated transferrin sat% and ferritin.  However, he did say I can do HFE test next time I need bloodwork but to wait until then.

Still, if my HFE test is negative, does that mean I don't need to worry anymore, or should I ask for follow up transferring sat% test & follow up ferritin test to see if those levels remain elevated.  

At current 61% saturation & 373 ferritin, my GI doctor thought those values were fine and not abnormal. However, the more research papers I look through about hemochromatosis, they say normal values are around 25% saturation and 150 ug/L ferritin...hence 60% transferrin sat% & 350 ug/L cutoffs for diagnosing hemochromatosis.

Am I worrying too much or should I keep pushing GI Dr for follow up blood panel (even if HFE test is negative) to see if transferrin sat% and ferritin remain high?

[Thomas D Schiano, MD]

if you have risk factors for fatty liver, the iron profile above can definitely be consistent with it.  it doesn't hurt to check HFE gene testing for peace of mind.  you may also want to check MRI instead of CT scan next time as MRI is a fairly good assessment for iron overload in liver.