From the Guidelines
To evaluate high ferritin levels, the initial step should involve assessing serum iron parameters, including transferrin saturation and serum ferritin, as recommended by the EASL clinical practice guidelines on haemochromatosis 1. When investigating elevated ferritin, it is crucial to consider conditions that may cause false positives, such as fatty liver disease, excess alcohol consumption, or metabolic syndrome, as these can also lead to elevated serum ferritin concentrations 1. Key tests to consider in the workup for high ferritin include:
- Serum iron and transferrin or total iron binding capacity for differential diagnosis, although this is a weaker recommendation 1
- Liver function tests, as elevated liver transaminases can indicate iron overload and haemochromatosis 1
- Complete blood count (CBC) and comprehensive metabolic panel (CMP) to rule out other causes of elevated ferritin, such as inflammation or certain cancers It's also important to note that measuring hepcidin is not recommended for diagnosing haemochromatosis 1. In individuals with a family history of haemochromatosis, HFE genotyping with appropriate genetic counselling may be necessary, particularly for first-degree relatives 1. Ultimately, a thorough clinical evaluation and interpretation of laboratory results are necessary to determine the cause of high ferritin levels and guide appropriate management.
From the Research
Labs to Check Ferritin Levels
To determine if ferritin is high, the following lab tests can be used:
- Serum ferritin test: This is the primary test used to assess iron stores in the body. A level of <30 ng/mL typically indicates iron deficiency, while higher levels may suggest adequate or excess iron stores 2.
- Transferrin saturation test: This test measures the percentage of transferrin that is saturated with iron. A transferrin saturation of less than 20% may indicate iron deficiency, while higher levels may suggest adequate or excess iron stores 2.
Interpretation of Results
It is essential to interpret the results of these lab tests in the context of the individual's clinical presentation and medical history. For example:
- Individuals with inflammatory conditions may have elevated ferritin levels due to inflammation, rather than iron overload 2.
- Pregnant women may have lower ferritin levels due to increased iron demands during pregnancy 2.
Diagnostic Criteria
The diagnosis of iron deficiency or iron overload is typically based on a combination of clinical evaluation, medical history, and laboratory test results, including:
- Serum ferritin levels
- Transferrin saturation
- Hemoglobin levels
- Clinical symptoms such as fatigue, weakness, or shortness of breath 2.