From the Guidelines
Ferritin levels should be interpreted in the context of iron deficiency, with low levels indicating a need for iron supplementation, and high levels potentially indicating iron overload, inflammation, or other conditions, as evidenced by studies such as 1 that highlight the importance of iron deficiency in chronic heart failure. Ferritin is a protein that stores iron in the body and releases it when needed. Normal ferritin levels typically range from 20-250 ng/mL for adult females and 30-300 ng/mL for adult males, though reference ranges may vary slightly between laboratories, as noted in studies like 1 that discuss serum ferritin concentration in relation to iron stores.
Key Points to Consider
- Low ferritin levels indicate iron deficiency, which can lead to anemia, fatigue, weakness, and impaired cognitive function, as discussed in 1.
- Treatment for low ferritin involves iron supplementation, typically with oral iron supplements like ferrous sulfate (325 mg, containing 65 mg elemental iron) taken 1-3 times daily between meals with vitamin C to enhance absorption.
- For severe deficiency or absorption issues, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be prescribed by a healthcare provider, as mentioned in 1.
- High ferritin levels can indicate iron overload conditions, inflammation, liver disease, or certain cancers, and the underlying cause determines treatment, which might include therapeutic phlebotomy for iron overload or addressing the primary inflammatory condition.
Importance of Monitoring Ferritin Levels
Regular monitoring of ferritin levels is important during treatment to ensure they return to normal range and to adjust therapy as needed, considering the potential for functional iron deficiency as discussed in 1 and the distinction between absolute and functional iron deficiency in conditions like chronic heart failure.
Clinical Decision Making
In clinical practice, the most recent and highest quality study 1 should guide decision-making, prioritizing the management of iron deficiency to improve outcomes in conditions like chronic heart failure, where iron deficiency is common and treatable.
From the Research
Definition and Diagnosis of Iron Deficiency and Overload
- Iron deficiency is defined as low iron stores with or without anemia, and can be diagnosed by low serum ferritin (typically <30 ng/mL) in individuals without inflammatory conditions or by transferrin saturation (iron/total iron binding capacity × 100) less than 20% 2.
- Ferritin concentration in the plasma or serum reflects iron stores, with low ferritin indicating iron deficiency and elevated ferritin reflecting risk of iron overload 3.
- The diagnostic accuracy of ferritin concentrations for detecting iron deficiency and risk of iron overload is generally good, but can be affected by inflammation and other factors 3.
Causes and Risk Factors of Iron Deficiency and Overload
- The most common causes of iron deficiency are bleeding (menstrual, gastrointestinal), impaired iron absorption (atrophic gastritis, celiac disease, bariatric surgical procedures), inadequate dietary iron intake, and pregnancy 2.
- Iron overload can occur due to chronic treatment with blood transfusions or hereditary hemochromatosis, and can also be caused by other conditions such as thalassemia syndromes, myelodysplastic syndrome, and chronic liver diseases 4.
- Risk factors for iron deficiency include heavy menstrual bleeding, pregnancy, and inflammatory bowel disease (IBD), while risk factors for iron overload include chronic inflammatory conditions, perioperative settings, and disorders associated with chronic blood loss 2, 5.
Treatment and Management of Iron Deficiency and Overload
- Oral iron (ferrous sulfate 325 mg/d or on alternate days) is typically first-line therapy for iron deficiency, while intravenous iron is indicated for patients with oral iron intolerance, poor absorption, or certain chronic inflammatory conditions 2, 5.
- Treatment of iron overload typically involves iron chelation therapy, and may also involve targeted pharmacological modulation of the hepcidin regulatory system 6.
- The evaluation of iron deficiency and iron overload is based on clinical and laboratory findings, imaging studies, and specific mutation analyses, and requires a multidisciplinary approach to manage effectively 5, 6.