Causes of Transient Ferritin Elevation
Transient ferritin elevation is most commonly caused by inflammatory conditions, including infections, liver disease, and rheumatologic disorders, as ferritin functions as an acute phase reactant that increases during inflammation. 1, 2
Common Causes of Transient Ferritin Elevation
Inflammatory Conditions
- Acute infections (both bacterial and viral) can cause ferritin levels to rise within days of onset and remain elevated for several weeks 2
- Chronic inflammatory conditions such as rheumatologic diseases can cause persistent ferritin elevation 1
- Liver diseases including alcoholic liver disease, viral hepatitis, and non-alcoholic fatty liver disease (NAFLD) commonly cause elevated ferritin 1, 3
Medication-Related Causes
- Iron supplements and iron-containing multivitamins directly increase ferritin levels 4
- Intravenous iron preparations used in chronic kidney disease can significantly raise ferritin 4
- Blood transfusions, particularly repeated ones, can lead to transient ferritin elevation 4
- Medications causing liver inflammation (e.g., statins, methotrexate) can indirectly raise ferritin levels 4
Other Common Causes
- Malignancy is frequently associated with markedly elevated ferritin levels 5
- Metabolic syndrome, obesity, and diabetes are associated with elevated ferritin, particularly in NAFLD 6, 3
- Alcohol consumption can lead to transient ferritin elevation 6
Mechanisms of Transient Ferritin Elevation
- Ferritin functions as an acute phase reactant during inflammation, increasing independently of iron status 4, 2
- Hepatocellular damage releases ferritin from damaged liver cells, resulting in elevated serum levels 4
- In NAFLD, ferritin elevation correlates with disease severity and is associated with advanced fibrosis 3
- Inflammatory cytokines (IL-1β, IL-6, TNFα) can stimulate ferritin production, as demonstrated in hepatic stellate cells 7
Evaluation of Elevated Ferritin
Initial Assessment
- Both serum ferritin and transferrin saturation should be measured together to properly evaluate iron status 1, 8
- Normal ferritin ranges: 24-336 ng/mL for men and 11-307 ng/mL for women 8
- Elevated ferritin with normal transferrin saturation (<45%) suggests an inflammatory cause rather than iron overload 1, 4
Further Evaluation
- Check inflammatory markers (CRP, ESR) to identify inflammatory causes 1
- Assess liver enzymes (ALT, AST) to evaluate for liver disease 1
- Review medication list for potential causes of ferritin elevation 4
- Consider specialized testing for extremely high ferritin levels (>10,000 ng/mL), which may suggest adult-onset Still's disease or hemophagocytic lymphohistiocytosis 1, 5
Clinical Pearls and Pitfalls
- 90% of elevated serum ferritin is due to non-iron overload conditions 6
- Ferritin elevation may persist for several weeks after resolution of the acute inflammatory stimulus 2
- Using ferritin alone without transferrin saturation to diagnose iron overload is a common pitfall 1, 8
- Referral to a specialist is appropriate if serum ferritin is >1000 µg/L or if the cause remains unclear 6
- Avoid unnecessary iron supplementation in patients with elevated ferritin unless iron deficiency is confirmed 4