Can my primary care provider (PCP) refer me to a gastroenterologist (GI) doctor for evaluation of hyperferritinemia and low ferritin levels?

Clarification Needed: Your Lab Results Require Reinterpretation

Your description of "high iron and low ferritin" is medically contradictory and requires immediate clarification with your provider before any GI referral is considered. This combination is extremely unusual and suggests either a laboratory error, misinterpretation of results, or a complex underlying condition that needs proper diagnosis first.

Understanding the Contradiction

Low ferritin typically indicates iron deficiency, not iron excess 1. The combination you describe doesn't fit standard patterns:

• If you have low ferritin (<45 ng/mL): This indicates depleted iron stores and would warrant GI evaluation for iron deficiency anemia, not "high iron" 1
• If you have high serum iron: This is inconsistent with low ferritin unless you have a rare condition like hemochromatosis with concurrent blood loss, or you recently took iron supplements before testing 1

When GI Referral IS Appropriate (If You Have Iron Deficiency)

Yes, your primary care provider can and should refer you to gastroenterology if you have confirmed iron deficiency anemia (hemoglobin <13 g/dL in men or <12 g/dL in women AND ferritin <45 ng/mL) 1.

Who Needs GI Evaluation:

• Men and postmenopausal women with iron deficiency anemia: Strong recommendation for bidirectional endoscopy (both upper and lower GI scopes) 1
• Premenopausal women with iron deficiency anemia: Conditional recommendation for GI evaluation, especially if no obvious menstrual cause 1
• Anyone with non-anemic iron deficiency (low ferritin but normal hemoglobin): Men and postmenopausal women should have a low threshold for investigation; premenopausal women generally don't need GI workup unless other concerning features present 1

The GI Evaluation Process:

Before endoscopy, your provider should order 1:

• Celiac disease serology (found in 3-5% of iron deficiency cases) 1
• H. pylori testing (non-invasive) 1
• Urinalysis to rule out urinary blood loss 1

If these are negative, bidirectional endoscopy is recommended to look for:

• Gastrointestinal bleeding sources (ulcers, cancers, vascular lesions) 1, 2
• Malabsorption conditions 3, 2

Critical Next Steps

Contact your provider immediately to:

1. Verify your actual lab values—specifically request the numeric values for serum ferritin, serum iron, transferrin saturation, and hemoglobin 1
2. Clarify whether you have iron deficiency (low ferritin) or iron overload (high ferritin)
3. Confirm whether you're actually anemic

Common pitfall: Ferritin can be falsely elevated by inflammation, infection, or chronic disease even when iron stores are actually low 1. A ferritin >150 ng/mL makes true iron deficiency unlikely, but values between 45-150 ng/mL can be misleading in inflammatory conditions 1.

If you truly have low ferritin: Yes, request the GI referral—85% of such patients have an identifiable GI cause 2, and missing GI malignancy carries significant mortality risk 1, 4.