What does elevated ferritin (iron storage protein) of 238 indicate in the presence of normal iron stores?

From the Guidelines

A ferritin level of 238 ng/mL with normal iron stores is likely indicative of adequate iron levels, but may also be influenced by inflammatory or metabolic conditions, and therefore, does not necessarily require treatment, but rather monitoring and consideration of lifestyle modifications. Ferritin is a protein that stores iron in the body, and levels between 20-250 ng/mL are typically considered normal for adult males, while 20-200 ng/mL is normal for adult females 1. Your level of 238 is within the upper range of normal, but as noted in the guidelines for the management of iron deficiency anaemia in adults, an SF value above 150 μg/L is unlikely to occur with absolute iron deficiency, even in the presence of inflammation 1.

Key Considerations

• Normal serum concentrations of ferritin essentially rule out iron overload, but elevated values can be the result of a range of inflammatory, metabolic, and neoplastic conditions 1
• Serum iron concentration and transferrin saturation do not quantitatively reflect body iron stores and should therefore not be used as surrogate markers of tissue iron overload 1
• Lifestyle factors that can elevate ferritin include alcohol consumption, inflammatory conditions, liver disease, or excessive iron supplementation 1

Recommendations

• Monitor ferritin levels periodically, especially if there are risk factors for iron overload such as hereditary hemochromatosis
• Consider lifestyle modifications, such as reducing red meat intake, avoiding iron supplements unless prescribed, and limiting alcohol consumption, if concerned about ferritin levels trending high-normal
• Be aware that ferritin is an acute phase protein and apparently normal levels may occur with iron deficiency in the context of an inflammatory disease process 1

From the Research

Ferritin and Iron Stores

• A ferritin level of 238 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 ferritin levels can be associated with inflammation, as serum ferritin is a well-known inflammatory marker 3, 2.
• High ferritin levels can also be a sign of disordered iron metabolism, which can signal disease severity and outcomes 2, 4.

Normal Iron Stores

• Normal iron stores are typically indicated by a transferrin saturation of 20-50% 2.
• Iron deficiency is diagnosed by low serum ferritin (typically <30 ng/mL) in individuals without inflammatory conditions or by transferrin saturation less than 20% 5.
• A ferritin level of 238 ng/mL, in combination with normal iron stores, may suggest that the elevated ferritin is not due to iron overload, but rather to inflammation or other factors 3, 2.

Potential Implications

• Elevated ferritin levels, even with normal iron stores, can be associated with increased mortality and disease severity 2, 4.
• Further investigation is needed to determine the underlying cause of the elevated ferritin level and to assess the risk of associated diseases 3, 2, 4.
• Reducing ferritin levels through iron reduction or other means may be beneficial for improving clinical outcomes, particularly in individuals with elevated ferritin levels 2, 6.