A patient with systemic lupus erythematosus (SLE) has been treated for anemia for about 6 months with erythropoietin (480 u/kg per week), but with no iron therapy because her serum ferritin is quite high and doctors are concerned about iron overload. Is the serum ferritin level a true measure of body iron stores and is it safe to give additional iron?

Also, I understand that lupus can blunt the marrow's response to EPO administration, so should the dosage be increased? She appears not to be responding to the present regimen (her hemoglobin has fallen to 5.9 g/dl).

Finally, doctors have suggested a splenectomy for this patient. I have read somewhere that this is not recommended. What is the current thinking on this?