Does an elevated ferritin level of 233 require further evaluation?

From the Guidelines

A ferritin level of 233 ng/mL does not necessarily require further evaluation for most adults, as it falls within the normal reference range. However, context matters in interpreting ferritin levels, and the decision to evaluate further should be based on individual patient factors, such as symptoms and medical history 1. If you're experiencing unexplained fatigue, joint pain, or have a family history of hemochromatosis (iron overload disorder), your doctor might want to monitor your levels over time or order additional tests like transferrin saturation or genetic testing 1. Ferritin is an acute phase reactant that can be elevated during inflammation, infection, or liver disease, so your doctor might consider these factors when interpreting your result 1. Some key points to consider in the evaluation of ferritin levels include:

• The first step in testing for haemochromatosis is the assessment of serum iron parameters, which should include transferrin saturation and serum ferritin 1
• Patients with haemochromatosis and iron overload should undergo therapeutic phlebotomy to reduce iron levels, with a target ferritin level of 50-100 lg/L 1
• Regular follow-up with your healthcare provider is recommended to monitor any changes in ferritin levels and to assess for signs and symptoms of iron overload or other related conditions 1. It's also important to note that the presence of other conditions, such as rheumatoid arthritis or the use of iron supplements, can affect the interpretation of ferritin levels 1. Ultimately, the decision to evaluate further or to initiate treatment should be based on a comprehensive assessment of the individual patient's clinical presentation and medical history, and should be made in consultation with a qualified healthcare provider 1.

From the Research

Evaluation of Ferritin Levels

• A ferritin level of 233 ng/mL is considered elevated, as optimal ferritin levels for cardiovascular mortality reduction are suggested to range from 20 to 100 ng/mL 2.
• Elevated serum ferritin levels are associated with increased mortality and disease severity, and levels above 194 ng/mL are associated with all-cause mortality in population cohorts 2.
• Hyperferritinemia is a non-specific finding that can be caused by various conditions, including iron overload, acute phase reactions, and underlying diseases 3.

Diagnostic Considerations

• Differentiation of the presence or absence of an associated iron overload upon hyperferritinemia is essential, although often proves to be complex 3.
• An algorithm for the diagnostic workup and management of hyperferritinemia is proposed, and general principles regarding the treatment of iron overload are discussed 3.
• Serum ferritin levels can correlate with both disease and body iron stores, and extremely elevated ferritin levels also occur in individuals with high mortality due to various diseases 4.

Clinical Implications

• The use of ferritin as a diagnostic test of iron deficiency and overload is a common clinical practice, but its accuracy can be affected by various factors, including inflammation and infection 5.
• A threshold of 30 micrograms/L is suggested as a reasonably sensitive and specific test for iron deficiency in people presenting for medical care, but there is very low certainty that high concentrations of ferritin provide a sensitive test for iron overload 5.
• Further evaluation is necessary to determine the underlying cause of elevated ferritin levels and to guide appropriate management, as ferritin levels above 200 ng/mL are associated with increased mortality and disease severity 2.