From the Guidelines
High ferritin levels with normal liver and iron markers may indicate inflammation rather than iron overload, and the best course of action is to identify and treat the underlying cause, rather than immediately pursuing iron reduction therapy like phlebotomy. This condition, known as hyperferritinemia, can be caused by various factors including chronic inflammation, metabolic syndrome, alcohol consumption, or certain medications 1. To address this, it's recommended to begin by consulting with your healthcare provider for a comprehensive evaluation. They may suggest lifestyle modifications such as reducing alcohol intake, improving diet, increasing physical activity, and managing stress. In some cases, anti-inflammatory medications might be prescribed if chronic inflammation is identified. Regular monitoring of ferritin levels is important to track progress.
- The high ferritin occurs because ferritin is an acute phase reactant that increases during inflammatory states, even when iron stores are normal 1.
- According to the EASL clinical practice guidelines on haemochromatosis, measuring hepcidin is not recommended, and biochemical findings that indicate haemochromatosis with iron overload include elevated transferrin saturation, high ferritin, and elevated liver transaminases 1.
- The American Association for the Study of Liver Diseases recommends that patients with hemochromatosis and iron overload should undergo therapeutic phlebotomy weekly, with target levels of phlebotomy being a ferritin level of 50-100 lg/L 1.
- However, in the absence of abnormal iron markers, phlebotomy may not be necessary, and the focus should be on addressing the underlying cause of the elevated ferritin levels 1.
From the Research
High Ferritin Levels with Normal Liver and Iron Markers
- High ferritin levels can be caused by various factors, including non-iron overload conditions, such as inflammation, metabolic syndrome, and liver disease 2, 3.
- In most cases, elevated serum ferritin is not due to iron overload, with 90% of cases attributed to non-iron overload conditions 3.
- Metabolic syndrome, which is characterized by insulin resistance, high blood pressure, and dyslipidemia, has been linked to high ferritin levels, even within the normal range 4, 5.
- The relationship between serum ferritin and metabolic syndrome has been observed in various studies, with increased ferritin levels correlating with the number of metabolic syndrome components 5.
- Investigation of high ferritin levels involves identifying underlying causes, such as alcohol consumption, metabolic syndrome, obesity, diabetes, liver disease, malignancy, infection, or inflammation 2, 3, 6.
- Serum transferrin saturation is a key test in the further investigation of unexpected raised serum ferritin, helping to distinguish between iron overload and other causes 2, 6.