From the Guidelines
Ferritin levels can be abnormal due to various health conditions, including iron deficiency, inflammation, liver disease, and certain cancers. When evaluating ferritin levels, it is essential to consider the clinical context, as ferritin is an acute phase reactant that can be elevated during inflammation or infection, potentially masking iron deficiency 1.
Causes of Abnormal Ferritin Levels
- Iron deficiency, which can be caused by blood loss, poor dietary iron intake, malabsorption disorders like celiac disease, or increased iron requirements during pregnancy
- Inflammation, which can lead to elevated ferritin levels independent of iron status
- Liver disease, which can affect iron storage and metabolism
- Certain cancers, which can cause elevated ferritin levels due to increased iron storage or inflammation
Diagnosis and Interpretation
For accurate diagnosis, ferritin should be interpreted alongside other iron markers like transferrin saturation and complete blood count 1.
- A ferritin level less than 15 μg L−1 confirms iron deficiency anaemia, while a level of 50 μg L−1 or higher may indicate iron deficiency in the presence of chronic inflammation
- Other markers of inflammation, such as C-reactive protein, and measures of iron status, such as total iron binding capacity, should be considered when interpreting ferritin levels 1
Treatment and Management
Treatment depends on the underlying cause of the abnormal ferritin level, and may include iron supplementation for deficiency or phlebotomy for excess iron 1.
- Iron supplementation is typically administered at a dose of 325mg ferrous sulfate 1-3 times daily for 3-6 months
- Lifestyle modifications, such as dietary changes, may also be recommended to address underlying causes of abnormal ferritin levels It is crucial to monitor laboratory parameters, including ferritin, transferrin saturation, and complete blood count, after treatment to assess response and adjust therapy as needed 1.
From the Research
Causes of Abnormal Ferritin Levels
- Abnormal ferritin levels can be caused by various conditions, including non-human immunodeficiency virus infection, solid tumor, liver dysfunction, renal failure, and hematological malignancy 2
- Ferritin levels can also be elevated in patients with chronic kidney disease (CKD) and iron deficiency 3
- Inflammation and infection can also cause elevated ferritin levels, as ferritin is an acute-phase protein 4
Diagnosis and Treatment of Iron Deficiency
- Serum ferritin concentration is a common diagnostic test for iron deficiency and overload, with low ferritin indicating iron deficiency and elevated ferritin reflecting risk of iron overload 4
- The diagnostic accuracy of ferritin concentrations for detecting iron deficiency and risk of iron overload varies depending on the population and clinical status 4
- Treatment of iron deficiency typically involves iron supplementation, with oral lactoferrin and ferrous sulfate being common supplements 5
- Guidelines for the diagnosis and treatment of iron deficiency vary widely across indications, with different recommendations for serum ferritin concentration and transferrin saturation (TSAT) thresholds 6
Factors Affecting Ferritin Levels
- Ferritin levels can be affected by various factors, including underlying medical conditions, inflammation, and iron supplementation 2, 3, 4, 5
- The level of serum ferritin is determined by the underlying conditions to a certain extent, but the variation is significant 2
- Multiple conditions can lead to elevated ferritin levels, and patients with hyperferritinemia often have multiple underlying causes 2