From the Guidelines
Elevated ferritin levels in the blood indicate excess iron storage in the body and require prompt evaluation by a healthcare provider to determine the underlying cause, which could be hemochromatosis, inflammation, liver disease, or certain cancers. The initial management typically involves diagnostic testing, including complete blood count, liver function tests, and transferrin saturation to determine the underlying cause 1.
Key Considerations
- For confirmed iron overload conditions like hemochromatosis, treatment may include therapeutic phlebotomy, limiting iron-rich foods, avoiding vitamin C with meals, and avoiding alcohol 1.
- Ferritin is an acute phase reactant that increases during inflammation, so elevated levels don't always indicate iron overload 1.
- Normal ferritin ranges are typically 20-250 ng/mL for men and 10-120 ng/mL for women, though reference ranges may vary between laboratories.
- Regular monitoring of ferritin levels is important during treatment to ensure they return to normal range.
Diagnostic Approach
- The initial approach to diagnosis is by indirect markers of iron stores, namely TS or unsaturated iron-binding capacity and serum ferritin 1.
- Serum ferritin levels have an additional value as a predictor of advanced fibrosis and cirrhosis in confirmed HH 1.
Treatment
- Therapeutic phlebotomy remains the mainstay of treatment for HH, with the goal of reducing tissue iron stores to normal 1.
- The frequency of maintenance phlebotomy varies among individuals, due to the variable rate of iron accumulation in HH 1.
Prognosis
- Early diagnosis and treatment of HH can improve survival, reduce the risk of complications, and improve quality of life 1.
- It is essential to consult with a healthcare provider for proper evaluation and management of elevated ferritin levels to prevent long-term complications and improve outcomes.
From the Research
Causes of Elevated Ferritin
- Elevated ferritin levels can be caused by various conditions, including inflammatory diseases, malignancies, iron-overload syndromes, and infections 2, 3
- A study found that the most frequent cause of hyperferritinemia was non-human immunodeficiency virus infection, followed by solid tumor, liver dysfunction, renal failure, and hematological malignancy 3
- Another study reported that the most frequent condition associated with elevated ferritin levels was malignancy, followed by iron-overload syndromes 2
Clinical Significance of Elevated Ferritin
- Hyperferritinemia can be a non-specific finding, and differentiation of the presence or absence of an associated iron overload is essential 4
- Elevated ferritin levels can be associated with both etiology and the number of underlying causes 3
- A review of the literature proposed an algorithm for the diagnostic workup and management of hyperferritinemia, and discussed general principles regarding the treatment of iron overload 4
Treatment of Iron Overload
- Desferrioxamine mesylate is a widely used iron chelator for managing transfusional iron overload in people with transfusion-dependent thalassaemia 5
- Deferasirox is a once-daily oral agent for iron overload that has been shown to be effective and well-tolerated 6
- The choice of iron chelation therapy depends on various factors, including the severity of iron overload, the presence of underlying conditions, and the patient's tolerance to the medication 5