Differential Diagnosis for High Ferritin, Normal Iron, Normal UIBC, and Normal TIBC
Single Most Likely Diagnosis
- Inflammation or Infection: Elevated ferritin levels can occur in response to inflammation or infection, as ferritin is an acute-phase reactant. Normal iron, UIBC, and TIBC levels suggest that the elevated ferritin is not due to iron overload.
Other Likely Diagnoses
- Metabolic Syndrome or Insulin Resistance: High ferritin levels have been associated with metabolic syndrome and insulin resistance, even in the absence of iron overload.
- Hemochromatosis (early stages): Although less likely given the normal iron and TIBC levels, early stages of hemochromatosis could present with elevated ferritin before significant iron accumulation occurs.
- Cancer (e.g., lymphoma, leukemia): Certain types of cancer can cause elevated ferritin levels, and it's essential to consider this possibility, especially if other symptoms or signs are present.
Do Not Miss Diagnoses
- Hemophagocytic Lymphohistiocytosis (HLH): This rare but life-threatening condition can cause extremely high ferritin levels, often >10,000 ng/mL. Although less likely, it's crucial to consider HLH due to its high mortality rate if left untreated.
- Sepsis or Severe Infection: In severe infections, ferritin can be markedly elevated, and it's essential to rule out sepsis or severe infection, especially in critically ill patients.
Rare Diagnoses
- Hyperthyroidism: Some cases of hyperthyroidism have been associated with elevated ferritin levels, although this is a rare cause.
- Porphyria Cutanea Tarda: This rare genetic disorder can cause elevated ferritin levels, often in conjunction with other symptoms like skin blistering and photosensitivity.
- Ferritinopathy: A rare genetic disorder characterized by elevated ferritin levels due to mutations in the ferritin gene, often without significant iron accumulation.