From the Guidelines
Elevated ferritin levels are most commonly caused by iron overload disorders, such as hemochromatosis, as well as chronic inflammatory conditions, liver diseases, and certain cancers, as indicated by recent studies 1. The causes of elevated ferritin levels can be diverse, including:
- Iron overload disorders like hemochromatosis, a genetic disorder that leads to excessive iron absorption
- Chronic inflammatory conditions such as rheumatoid arthritis, lupus, and inflammatory bowel disease, which can raise ferritin as part of the acute phase response
- Liver diseases including hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, often causing elevated ferritin due to damaged liver cells releasing stored ferritin
- Certain cancers, particularly leukemia, lymphoma, and breast cancer, which may increase ferritin production
- Frequent blood transfusions leading to iron overload and high ferritin levels
- Metabolic syndrome, characterized by obesity, insulin resistance, and hypertension, associated with elevated ferritin
- Other causes such as excessive alcohol consumption, hyperthyroidism, and certain medications It's essential to note that ferritin is an iron storage protein, and when its levels are high, it typically indicates either excess iron storage or an inflammatory response where ferritin increases as a protective mechanism. Further testing is usually needed to determine the specific cause of elevated ferritin, which may include iron studies, liver function tests, and sometimes genetic testing, as suggested by studies 1. In clinical practice, distinguishing between absolute and functional iron deficiency is crucial, and serum ferritin levels, along with transferrin saturation, play a significant role in this assessment, as discussed in 1. However, given the most recent and highest quality evidence, the primary concern with elevated ferritin levels is the potential for underlying iron overload or chronic inflammation, which necessitates thorough evaluation and appropriate management to prevent long-term complications, as emphasized in 1 and 1.
From the Research
Causes of Elevated Ferritin Levels
Elevated ferritin levels can be caused by a variety of conditions, including:
- Inflammatory conditions such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome 2
- Malignancy, which was the most frequent condition associated with elevated ferritin levels in one study 2
- Iron-overload syndromes, which were the second most common condition associated with elevated ferritin levels in the same study 2
- Anemia of chronic inflammation 2
- Infection 2
- Metabolic syndrome, which is characterized by insulin resistance, fatty liver, and other conditions 3
- Dysmetabolic hyperferritinemia, which is a condition characterized by elevated ferritin levels without iron overload 4
Conditions Associated with Elevated Ferritin Levels
Some conditions that are associated with elevated ferritin levels include:
- Hereditary hemochromatosis, a genetic disorder that causes iron overload 4, 5
- Inflammatory bowel disease (IBD), chronic heart failure (CHF), and chronic kidney disease (CKD), which can cause iron deficiency despite normal or high ferritin levels 6
- Liver disease, such as cirrhosis, which can cause elevated ferritin levels 4
- Arthropathy, particularly of the metacarpophalangeal joints, which is associated with iron overload 5
Laboratory Changes Associated with Elevated Ferritin Levels
Some laboratory changes that are associated with elevated ferritin levels include: