From the Guidelines
Elevated ferritin levels indicate excess iron storage in the body, which can result from several conditions, including iron overload disorders like hemochromatosis, chronic inflammation, liver disease, certain cancers, metabolic syndrome, and excessive alcohol consumption. The most common causes of elevated ferritin levels include:
- Iron overload disorders like hemochromatosis
- Chronic inflammation
- Liver disease
- Certain cancers
- Metabolic syndrome
- Excessive alcohol consumption Ferritin is an acute phase reactant, meaning it increases during inflammatory states even when iron stores are normal. Normal ferritin levels typically range from 20-250 ng/mL for women and 30-300 ng/mL for men, though reference ranges vary by laboratory 1. If your ferritin level is elevated, further testing is usually needed to determine the underlying cause, which may include transferrin saturation, complete blood count, liver function tests, and possibly genetic testing for hereditary hemochromatosis. Treatment depends on the underlying cause - for iron overload, therapeutic phlebotomy (blood removal) may be recommended, while addressing the primary condition is necessary for other causes. Untreated iron overload can lead to serious complications including liver damage, heart problems, diabetes, and joint pain, making proper diagnosis and management essential 1.
In patients with hereditary hemochromatosis, serum ferritin levels have been shown to correlate with liver iron and development of cirrhosis, and a ferritin level greater than 200 µg/mL and transferrin saturation greater than 55% suggest an increased risk for hereditary hemochromatosis and the need for further investigation 1.
It's worth noting that ferritin levels can also be elevated in the absence of iron overload, such as in cases of chronic inflammation or liver disease, and that a diagnosis of iron overload should be made based on a combination of clinical and laboratory findings, including transferrin saturation, serum ferritin, and genetic testing for hereditary hemochromatosis 1.
Overall, elevated ferritin levels require further evaluation to determine the underlying cause and to guide appropriate treatment, with the goal of preventing complications and improving quality of life.
From the Research
Elevated Ferritin Levels: Indications and Implications
Elevated ferritin levels can indicate an excess of iron in the body, which can be caused by various conditions. Some of the possible causes and implications of high ferritin levels include:
- Iron overload syndromes, such as hemochromatosis 2, 3
- Malignancy 4
- Inflammatory conditions, such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome 4
- Anemia of chronic inflammation 4
- Iron overload accompanying chronic anemia 3
- Liver disease, such as cirrhosis 3
- Kidney transplantation and subsequent iron overload 5
Diagnostic and Prognostic Value of Ferritin Levels
Ferritin levels can be used as a diagnostic tool to assess iron stores in the body. A high ferritin level can indicate iron overload, while a low level can indicate iron deficiency. The correlation between ferritin levels and body iron stores has been studied, and it has been found that serum ferritin is a good predictor of body iron stores 2. However, the correlation is not very strong, even in patients with genetic mutations that affect iron metabolism 2.
Clinical Significance of Elevated Ferritin Levels
Elevated ferritin levels can have significant clinical implications, including:
- Increased risk of liver disease and liver damage 3, 5
- Increased risk of cardiovascular disease 5
- Increased risk of infections and inflammatory conditions 4
- Impaired glucose metabolism and increased risk of diabetes 5
- Hemosiderin deposition in tissues, leading to organ damage 6
Measurement and Interpretation of Ferritin Levels
Ferritin levels can be measured using serum ferritin kinetics, which can provide information on the storage iron metabolism in the body 6. The measurement of ferritin levels can be used to diagnose and monitor iron overload conditions, as well as to assess the effectiveness of treatment 3, 6. However, the interpretation of ferritin levels requires careful consideration of the clinical context and other laboratory results 2, 4.