From the Guidelines
Ferritin levels over 1000 ng/mL are most commonly caused by iron overload disorders, such as hereditary hemochromatosis, and can also be elevated in chronic liver diseases, inflammatory conditions, metabolic syndrome, and certain cancers. The causes of ferritin over 1000 ng/mL can be multifactorial, including:
- Iron overload disorders like hereditary hemochromatosis, where genetic mutations lead to excessive iron absorption 1
- Frequent blood transfusions, which can accumulate iron in the body
- Chronic liver diseases, such as alcoholic liver disease, hepatitis, and non-alcoholic fatty liver disease, which can cause liver inflammation and impaired iron metabolism
- Inflammatory conditions, like rheumatoid arthritis, lupus, and certain infections, which can raise ferritin as part of the acute phase response
- Metabolic syndrome, characterized by obesity, diabetes, and hypertension, which is increasingly recognized as a cause of hyperferritinemia
- Rare conditions, like Still's disease and hemophagocytic lymphohistiocytosis, which can cause extremely high ferritin levels
- Certain cancers, particularly leukemia, lymphoma, and breast cancer, which may elevate ferritin It is essential to consult with a healthcare provider promptly for proper evaluation, which typically includes additional blood tests, genetic testing for hemochromatosis, and possibly liver imaging or biopsy to determine the underlying cause and appropriate treatment 1.
From the Research
Causes of Ferritin Over 1000
The causes of ferritin levels over 1000 can be varied and complex. Some of the possible causes include:
- Malignancy: Studies have shown that malignancy is a common cause of elevated ferritin levels, with one study finding that 153 out of 627 patients with ferritin levels over 1000 had malignancy 2.
- Iron-overload syndromes: Iron-overload syndromes, such as hereditary hemochromatosis, can also cause elevated ferritin levels, with one study finding that 136 out of 627 patients with ferritin levels over 1000 had iron-overload syndromes 2.
- Inflammatory conditions: Inflammatory conditions, such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome, can also cause elevated ferritin levels, with one study finding that 6 out of 627 patients with ferritin levels over 1000 had these conditions 2.
- Infection: Non-human immunodeficiency virus infection is also a common cause of hyperferritinemia, with one study finding that it was the most frequent cause of hyperferritinemia in a general hospital 3.
- Liver dysfunction: Liver dysfunction can also cause elevated ferritin levels, with one study finding that it was a common cause of hyperferritinemia in a general hospital 3.
- Renal failure: Renal failure can also cause elevated ferritin levels, with one study finding that it was a common cause of hyperferritinemia in a general hospital 3.
- Hematological malignancy: Hematological malignancy can also cause elevated ferritin levels, with one study finding that it was a common cause of hyperferritinemia in a general hospital 3.
- Porphyria cutanea tarda: Porphyria cutanea tarda is a unique iron-related disorder that can cause elevated ferritin levels, with one study finding that it was associated with hereditary hemochromatosis and hepatocellular carcinoma 4, 5, 6.
Other Possible Causes
Other possible causes of ferritin levels over 1000 include:
- Anemia of chronic inflammation: One study found that 7 patients with ferritin levels over 1000 had anemia of chronic inflammation 2.
- Unknown causes: In some cases, the cause of elevated ferritin levels may be unknown, with one study finding that 5 out of 627 patients with ferritin levels over 1000 had no clearly definable cause for hyperferritinemia 2.