What is the significance of hyperferritinemia (elevated ferritin level)?

From the Guidelines

A ferritin level of 498 ng/mL is elevated and requires immediate attention to prevent potential organ damage, and phlebotomy therapy should be considered as a treatment option to reduce iron levels, as recommended by the most recent guidelines 1. The elevated ferritin level suggests excess iron storage in the body, which can lead to serious complications such as cirrhosis, diabetes, or heart problems if left untreated. The causes of elevated ferritin can include hemochromatosis, liver disease, inflammation, or certain anemias, and further evaluation is necessary to determine the underlying cause. This evaluation will likely include additional blood tests such as transferrin saturation, complete blood count, and liver function tests. Dietary modifications to reduce iron intake, such as limiting red meat, iron-fortified foods, vitamin C with meals, and alcohol consumption, may also be recommended. However, according to the latest guidelines, phlebotomy therapy is the most effective treatment for reducing iron levels and preventing organ damage, and it should be performed every 1-2 weeks until ferritin levels normalize, with a target level of 50-100 lg/L 1. It is essential to note that vitamin C supplements and iron supplements should be avoided during treatment, as they can accelerate iron mobilization and increase the risk of organ damage 1. Regular monitoring of ferritin levels and liver function tests is crucial to assess the effectiveness of treatment and prevent potential complications. In some cases, MRI may be used to non-invasively quantify iron overload and guide diagnosis and management, especially in patients with suspected hemochromatosis or other iron overload disorders 1. Overall, prompt treatment and regular monitoring are essential to prevent the potential consequences of elevated ferritin levels and ensure the best possible outcomes for patients.

From the Research

Elevated Ferritin Level

• A ferritin level of 498 is considered elevated, but not extremely high compared to the levels reported in the studies 2, 3, 4.
• Elevated ferritin levels can be caused by various conditions, including:
  • Inflammatory conditions such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome 2, 3, 4
  • Malignancy 2, 3, 4
  • Iron-overload syndromes 2
  • Infections 3, 4
  • Anemia of chronic inflammation 2, 5
• The most common cause of hyperferritinemia in rheumatology practice is rheumatological diseases, followed by infections, iron overload, and solid malignancy 3.
• Ferritin levels can be significantly higher in certain conditions, such as adult-onset Still's disease, and can be associated with a higher mortality rate 3, 4.

Diagnostic Approach

• A diagnostic workup for hyperferritinemia should include a thorough medical history, physical examination, and laboratory tests to rule out underlying conditions 6.
• The H score can be used as a screening tool to evaluate the possibility of hemophagocytic lymphohistiocytosis (HLH) in patients with extremely high ferritin levels 4.
• Differentiation between iron overload and non-iron overload causes of hyperferritinemia is essential for proper management 6.