What does a ferritin level of 211 indicate and how is it treated?

Interpretation of Ferritin Level of 211

A ferritin level of 211 μg/L is within normal range for most adults and does not indicate iron deficiency or significant iron overload, but should be interpreted in the context of other clinical and laboratory parameters.

Understanding Ferritin Values

Ferritin is an iron storage protein that reflects the body's iron stores. According to current guidelines:

• Normal ferritin ranges:
  • Men: 20-200 μg/L 1
  • Women: 15-150 μg/L 1

A value of 211 μg/L is:

• Slightly elevated for women
• At the upper end of normal for men

Clinical Interpretation Algorithm

Step 1: Assess for Iron Deficiency

• Ferritin <45 μg/L indicates iron deficiency 1
• At 211 μg/L, iron deficiency is effectively ruled out

Step 2: Assess for Iron Overload

• Significant iron overload is typically associated with ferritin >1000 μg/L 1
• A ferritin of 211 μg/L does not suggest significant iron overload
• For hemochromatosis evaluation, both ferritin and transferrin saturation (TS) should be measured 1
  • If TS ≥45%, consider HFE genetic testing 1
  • If TS <45% with ferritin of 211 μg/L, hemochromatosis is unlikely

Step 3: Consider Inflammatory Causes

• Ferritin is an acute phase reactant that increases during inflammation 1
• Mild elevation may reflect:
  • Chronic inflammation
  • Liver disease
  • Malignancy
  • Obesity 2

Action Plan Based on Ferritin of 211 μg/L

1. For men: This value is at the upper end of normal range and generally requires no specific treatment.

2. For women: This value is mildly elevated above the reference range.

   • Check transferrin saturation (TS)
   • If TS ≥45%, consider HFE genetic testing 1
   • If TS <45%, evaluate for inflammatory conditions

3. For both genders:

   • Check liver enzymes (ALT/AST) - elevated enzymes with ferritin >200 μg/L may suggest early iron overload 3
   • Consider C-reactive protein to assess for inflammation
   • Evaluate for metabolic syndrome, obesity, or fatty liver disease

Important Caveats

• Ferritin must be interpreted in context of other clinical parameters, not in isolation 1
• In obesity, ferritin may be elevated due to inflammation rather than iron overload 2
• Ferritin levels between 200-1000 μg/L represent a gray zone where clinical correlation is essential 1
• Ferritin can be falsely elevated in:
  • Acute or chronic inflammation
  • Liver disease
  • Malignancy
  • Renal failure

Follow-up Recommendations

• If no clinical concerns and normal transferrin saturation, routine monitoring is reasonable
• If ferritin continues to rise on subsequent testing, further evaluation for iron overload disorders may be warranted
• In patients with risk factors for hemochromatosis (family history, joint pain, liver disease), consider HFE genetic testing even with borderline ferritin values 1

Remember that a single ferritin value of 211 μg/L by itself is not diagnostic of any specific condition and should be interpreted as part of a complete clinical picture.