What is the significance of a ferritin level of 102 micrograms per liter (μg/L), indicating elevated ferritin?

From the Guidelines

Your ferritin level of 102 ug/L is within the normal range, which typically spans from about 20 to 250 ug/L for adults, though reference ranges may vary slightly between laboratories. No specific treatment or intervention is needed for this ferritin level. Ferritin is a protein that stores iron in your body, and your current level indicates adequate iron stores without evidence of iron deficiency or iron overload. This normal ferritin level suggests your body has sufficient iron for essential functions like oxygen transport in red blood cells and various enzymatic processes. If you were experiencing symptoms that prompted this test, they are likely not related to iron status, and further evaluation of other potential causes would be appropriate. Routine monitoring of ferritin levels is not necessary unless you have specific risk factors for iron disorders or develop symptoms suggesting iron imbalance such as unusual fatigue, weakness, or changes in your blood counts.

Key Points to Consider

• The normal range for ferritin levels can vary between laboratories, but generally falls between 20 to 250 ug/L for adults 1.
• A ferritin level of 102 ug/L is considered normal and does not indicate iron deficiency or iron overload.
• In the presence of inflammation, serum ferritin levels can be elevated, and a level up to 100 mg/L may still be consistent with iron deficiency 1.
• The European Crohn's and Colitis Organization (ECCO) guidelines recommend intravenous iron as first-line treatment in patients with clinically active IBD, with previous intolerance to oral iron, with hemoglobin below 100 g/L, and in patients who need erythropoiesis-stimulating agents 1.

Recommendations for Monitoring and Treatment

• Routine monitoring of ferritin levels is not necessary unless you have specific risk factors for iron disorders or develop symptoms suggesting iron imbalance 1.
• If you have a history of iron deficiency or iron overload, your healthcare provider may recommend regular monitoring of your ferritin levels 1.
• In patients with inflammatory bowel disease (IBD), iron supplementation is recommended when iron-deficiency anemia is present, and intravenous iron may be considered as first-line treatment in certain cases 1.

From the Research

Ferritin Level Interpretation

• A ferritin level of 102 ug/L is above the threshold of 50 microg/L suggested by the British Society of Gastroenterology (BSG) as consistent with iron deficiency in the presence of coexistent pathology 2.
• However, a study published in the European journal of internal medicine in 2009 found that a ferritin level >50 microg/L is frequently consistent with iron deficiency, and patients with normocytic anaemia who have ferritin levels above 50 microg/L should not automatically be considered to have adequate iron stores 2.
• Another study published in Metallomics in 2021 suggests that optimal serum ferritin level range for iron status measure and inflammatory biomarker is between 20 to 100 ng mL-1, and levels above 194 ng mL-1 associate with all-cause mortality in population cohorts 3.

Iron Homeostasis and Ferritin

• Ferritin plays a central role in iron balance, and serum ferritin is a convenient reporter of body iron stores 4.
• Ferritin has a broad role to play in new strategies for managing Cooley's anemia and the thalassemias, and its iron mineral content can be targeted by chelators 5.
• The iron pore gating property of ferritin is a key regulator of cellular iron homeostasis, and exploration of food ferritin as a potentially safer form of dietary nonheme iron is an area of ongoing research 5.

Clinical Implications

• Elevated serum ferritin levels are associated with increased mortality and reduced mortality at ferritin levels <100 ng mL-1 3.
• Vitamin C supplementation can increase the efficacy of iron chelators such as deferoxamine (DFO) in reducing iron burden in patients with β-thalassemia major 6.
• The use of ferritin levels as a measure of iron status and inflammation can inform clinical decision-making and guide therapy in patients with iron overload conditions 3.