From the Guidelines
Elevated ferritin levels can be caused by several conditions, including iron overload disorders, chronic inflammatory conditions, liver diseases, certain cancers, and metabolic syndrome, as well as other factors such as excessive alcohol consumption, hyperthyroidism, and certain medications, as noted in the most recent guidelines 1.
Causes of Elevated Ferritin Levels
The causes of elevated ferritin levels can be broadly categorized into several groups:
- Iron overload disorders, such as hemochromatosis, which is a genetic disorder causing excessive iron absorption, frequently leading to high ferritin levels 1.
- Chronic inflammatory conditions, like rheumatoid arthritis, lupus, and inflammatory bowel disease, which can raise ferritin as part of the acute phase response 1.
- Liver diseases, including hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, often showing elevated ferritin due to damaged liver cells releasing stored ferritin 1.
- Certain cancers, particularly leukemia, lymphoma, and breast cancer, may increase ferritin production 1.
- Frequent blood transfusions can cause iron overload, especially in conditions like thalassemia or sickle cell disease 1.
- Metabolic syndrome, characterized by obesity, insulin resistance, and hypertension, is associated with higher ferritin levels 1.
- Other causes include excessive alcohol consumption, hyperthyroidism, and certain medications, as well as acute infections, which can elevate ferritin as part of the body's immune response 1.
Importance of Context
It's crucial to consider the context when interpreting high ferritin results, as ferritin is not only a marker of iron overload but also an acute phase reactant, tumor marker, and indicator of increased angiogenesis, and can be released from necrotic or lysed cells 1.
Diagnostic Approach
The diagnostic approach to elevated ferritin levels should include assessing serum iron parameters, such as transferrin saturation and serum ferritin, and considering common causes of hyperferritinemia before genetic tests are carried out 1.
Recent Guidelines
Recent guidelines, such as those from the European Association for the Study of the Liver (EASL) 1, emphasize the importance of considering the clinical context and common causes of elevated ferritin levels when interpreting results and making diagnostic decisions.
From the Research
Causes of Elevated Ferritin Levels
Elevated ferritin levels can be caused by various conditions, including:
- Malignancy: Studies have shown that malignancy is a common cause of elevated ferritin levels, with one study finding that 153 out of 627 patients with elevated ferritin levels had malignancy 2
- Iron-overload syndromes: Iron-overload syndromes, such as hereditary hemochromatosis, can also cause elevated ferritin levels 2, 3
- Inflammatory conditions: Inflammatory conditions, such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome, can cause elevated ferritin levels 2
- Insulin resistance and fatty liver: Hyperferritinemia has been associated with insulin resistance and fatty liver in patients without iron overload 4
- Genetic disorders: Certain genetic disorders, such as hereditary hyperferritinaemia not related to iron overload, can cause elevated ferritin levels 5
- Anemia of chronic inflammation: Anemia of chronic inflammation can also cause elevated ferritin levels 2
- Infection: Infection can cause elevated ferritin levels, although this is not as common as other conditions 2
Other Possible Causes
Other possible causes of elevated ferritin levels include:
- Liver steatosis: Liver steatosis has been found in patients with hyperferritinemia, particularly those with insulin resistance and fatty liver 4
- Congenital cataract: A linkage between hereditary hyperferritinaemia not related to iron overload and autosomal dominant congenital cataract has been found 5
- Chronic kidney disease: Chronic kidney disease can make it challenging to diagnose iron deficiency using serum ferritin and transferrin saturation, and alternative markers such as reticulocyte hemoglobin content and soluble transferrin receptor may be useful 6