From the Guidelines
Ferritin levels can be abnormal due to various health conditions, including iron overload disorders, inflammation, liver disease, certain cancers, or metabolic syndrome, as well as iron deficiency resulting from blood loss, poor dietary iron intake, or increased iron requirements during pregnancy, as noted in studies such as 1 and 1. When evaluating abnormal ferritin levels, it is essential to consider other iron markers like transferrin saturation and complete blood count.
- Elevated ferritin often indicates iron overload disorders like hemochromatosis, inflammation, liver disease, certain cancers, or metabolic syndrome.
- Low ferritin typically suggests iron deficiency, which may result from blood loss, poor dietary iron intake, malabsorption disorders, or increased iron requirements during pregnancy.
- Certain medications like erythropoietin can also affect ferritin levels, as discussed in 1. The interpretation of abnormal ferritin should consider the patient's overall clinical context, including the presence of inflammation, as ferritin is an acute phase reactant that can rise during inflammation independent of iron status, which can sometimes mask underlying iron deficiency, as noted in 1. Treatment depends on the underlying cause - iron supplementation for deficiency (typically ferrous sulfate 325mg daily for 3-6 months) or phlebotomy for iron overload.
- Identifying and addressing the root cause of abnormal ferritin is essential for proper management, as emphasized in 1. In clinical practice, the most recent and highest quality study 1 provides valuable guidance on the diagnosis and management of iron deficiency and iron overload disorders, highlighting the importance of considering the patient's inflammatory status and using a combination of iron markers to guide diagnosis and treatment.
From the Research
Abnormal Ferritin Levels
Abnormal ferritin levels can be caused by various factors, including:
- Iron deficiency or overload 2, 3, 4
- Inflammation or infection, as ferritin is an acute-phase protein 2, 5
- Chronic kidney disease (CKD) 6, 4
- Malignancy 5
- Neurodegenerative disorders 5
- Hemophagocytic syndrome 5
- Sideroblastic anemias 5
Diagnosis and Treatment
Ferritin concentration is recommended by WHO as a biomarker to assess iron status in individuals and populations 3, 4.
- For iron deficiency, a cutoff of 100 μg/L for serum ferritin concentration should be considered in most conditions 4
- For iron overload, ferritin concentration would only help in the presumptive diagnosis and guide the need for further assessment 3
- Treatment targets for iron deficiency included an increase in hemoglobin concentrations to 10-12 g/dL or normalization, and serum ferritin >100 μg/L or 200 μg/L 4
Ferritin as a Diagnostic Test
Ferritin is a reasonably sensitive and specific test for iron deficiency in people presenting for medical care 2.
- At a threshold of 30 micrograms/L, there is low-certainty evidence that blood ferritin concentration is a sensitive test for iron deficiency 2
- However, there is very low certainty that high concentrations of ferritin provide a sensitive test for iron overload in people where this condition is suspected 2