Spike in Iron levels

Hi all,
I’m a 35 yr old man, diagnosed with chronic Hep B in 2019. I started viral treatment (Entercavir) in September 2020. I started off wrong for the first month, taking the tablets first thing in the morning but eating breakfast only 45 mins after (as directed incorrectly by the pharmacist). Once I realised this, I contacted my doctor who said it wasn’t much of an issue but to get on to the correct method of waiting 2 hrs.
I started to experience some pain in my sides over the Christmas week but I’m not sure if it was just weight gain and all that sugar but that’s sort of subsided now. Went for a blood test in early Jan this year and my viral count has gone from about 1.3m to 59. So big decrease! And liver functions seemed normal.
However,there was a big spike in my iron levels (600 compared to the max of 300 as expected for a man). I have another blood test scheduled in 6 months where she’ll follow up on the iron and check if there are any antibodies developed as well.
I’m wondering if anyone has experienced/noticed any increase in iron levels after going on medication or as a result of chronic Hep B?
Googling information online just adds to my anxiety as it goes to the worst case scenario (hemochromatosis).

Hi Jonathan, I haven’t heard of iron levels increasing because of hep B or starting treatment for it. But sounds like your doctor is on top of it since she wants to re-test you again in 6 months. Not sure what your “baseline” iron level was since you didn’t mention what it was before you were tested in January. With that said, hopefully one of the scientists or clinicians on this forum might be able to answer? My best advice is to try to not worry too much and wait until you get tested again in 6 months. In the meantime, take good care of yourself by eating well and keeping your stress level as low as possible. Thanks so much for joining the group!! Joan

Thanks Joan! And thank you for the welcome :slight_smile:

My GP never mentioned iron levels when going over prior blood tests so I’m assuming it was normal? Although, he never mentioned it this time either and it was the liver specialist who brought it up.

I’ve contacted my GP to go over prior tests results to see if I can find out what the iron levels were previously. In the meantime I’ll try to relax and not worry about it (which is not easy for me!!)

I know, it’s not easy to relax when you’re told something is “not normal.” So glad to hear that you’re seeing a hepatologist (liver specialist) since they will be able to better explain why your iron levels are increasing? I had the exact opposite problem several years ago. And boy was it a mess - lots of tests, colonoscopies and endoscopies to try to figure out why I had such extremely low iron levels. My hemoglobin (which is the iron carried by your blood cells and the blood test for checking for anemia) was normal. It was my ferritin and stored iron levels that were abnormally low. Anyhow, to make a long story short, I did not have some kind of invisible blood leak (i.e intestines, colon, esophagus or stomach) or any type of cancer. So, I’m just living with an abnormally low stored iron levels and ferritin which my hepatologist is now OK with. If I ever switch doctors, I’ll have to explain it all over again since specialists never like to see abnormal lab results like ours!! Oh and BTW, you could contact your hepatologist to ask her why she thinks your iron levels have increased? She may or may not answer, but at least you can try. With that said, please keep us posted on what you learn and your progress. Thanks again, Joan


I agree this is not something I have seen much and I would not be too concerned. Iron levels can fluctuate for a range of reasons. Haemochromatosis is a genetic condition and does not present quickly like that, and your ferritin level (which reflects total iron stores) is more important to look for that than serum iron. It sounds like your doctor is on top of it and will follow up, but in the meantime I wouldn’t worry. The main thing is the virus is responding well to the entecavir - keep up the good work!


Hi Mark, thanks for your reply! It did give me some hope that it’s not the worst case scenario.

Checked with GP today and we didn’t really have any data for my ferritin levels until this one just done that showed the spike (ferritin levels were 600).So there was nothing for me to compare to unfortunately to check if this was a sudden spike or a steady increase. He thinks it could be the result of starting new meds and will settle down but he has prescribed a blood test to check for hemachromatosis with my next scheduled blood test as well. So let’s see what turns up, but I’ll try to stay anxiety free in the meantime.

Just feels good to have this community to share these thoughts and feelings with.

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Thanks Jonathan for updating us on your ferritin levels. Please keep us posted since it’s helpful to the rest of us. We all learn from hearing one another’s situation. Really glad you were able to follow up with your GP. Always, Joan

Hi Joan, good to ”see” you again here! I seem to have the same situation as you- low ferritin but normal hemoglobin, with no known GI bleed. I’m currently supplementing with oral iron and vitamin C but am a little unsure if this such a good idea as I’ve previously read that the HBV virus “feeds” on iron and it can also be a little rough on the digestive system. I’m curious if low ferritin might just be normal with us lifelong HBVers?

Hi Karin,

Welcome to HepBCommunity. I am not aware of any studies showing abnormal ferritin levels being associated with chronic Hep B. I think increased has been seen in cirrhotic patients, but that is more to do with disruption of liver metabolism and function.

Maybe @MarkDouglas knows a bit more, given he sees patient lab results on a daily basis.


Hi Karin, so good to see YOU on this new patient forum! Hope more of you HB-List “lifers” join as well since you have so much expertise and experience to add to these conversations!! In regards to my very low ferritin levels (9-11), I’ve been worked up the wazoo for any kind of GI bleeds and tested for other hematologic disorders with nothing found. So my hepatologist reassures me it’s ok and that in actuality, low ferritin and iron levels are good for hep b patients. She has conducted studies that show correlation between high iron and HCC. Since my hemoglobin is normal, I’m considered fine. But the very low ferritin levels does explain why I get more fatigued than others. Oh well, at 62 now I’m expected to have “slowed down.” Ha, ha … And for those reading this post, Karin was a former Olympic speed skater!!! So clearly, her hep b did not slow her down :slight_smile: Thanks, Joan