How can I increase serum ferritin levels?

From the Guidelines

To increase ferritin levels, it is recommended to start with oral iron supplementation, and if that is not effective, consider intravenous iron infusions, as they can rapidly replenish iron stores and improve hemoglobin levels, as seen in the 2024 study published in Clinical Gastroenterology and Hepatology 1. When considering oral iron supplementation, it is essential to consume iron-rich foods like red meat, liver, beans, spinach, and fortified cereals daily, and pair these with vitamin C sources such as citrus fruits, bell peppers, or tomatoes to enhance iron absorption.

• Key points to consider when taking oral iron supplements include:
  • Taking ferrous sulfate 325mg once or twice daily, on an empty stomach with vitamin C
  • Avoiding taking supplements with calcium, coffee, tea, or dairy products as these inhibit absorption
  • Monitoring progress and adjusting the approach as needed, with ferritin levels expected to increase within a month of supplementation, as noted in the 2024 study published in Clinical Gastroenterology and Hepatology 1 For severe iron deficiency, intravenous iron infusions like iron sucrose or ferric carboxymaltose may be prescribed by a doctor, as they can provide a rapid increase in ferritin levels, with hemoglobin levels expected to increase by 1 g/dL within 2 weeks of supplementation, as seen in the 2024 study published in American Journal of Hematology 1.
• When using intravenous iron infusions, it is crucial to:
  • Monitor laboratory parameters, including CBC and iron parameters, 4 to 8 weeks after the last infusion, as recommended in the 2024 study published in American Journal of Hematology 1
  • Aim for a goal ferritin level of 50 ng/mL, regardless of sex at birth, in the absence of inflammation, as noted in the 2024 study published in American Journal of Hematology 1 Addressing underlying causes of low ferritin, such as blood loss, poor diet, or malabsorption conditions, is also vital to effectively increase ferritin levels and prevent future deficiencies.

From the FDA Drug Label

Following intravenous administration, Venofer is dissociated into iron and sucrose and the iron is transported as a complex with transferrin to target cells including erythroid precursor cells. Serum ferritin increased at endpoint of study from baseline in the Venofer-treated population (165.3 ± 24.2 ng/mL) compared to the historical control population (-27.6 ± 9. 5 ng/mL). Increases from baseline in mean hemoglobin (1. 7 g/dL), hematocrit (5%), serum ferritin (434.6 ng/mL), and serum transferrin saturation (14%) were observed at week 2 of the observation period and these values remained increased at week 4 of the observation period.

To increase ferritin levels, intravenous iron supplementation with Venofer (iron sucrose) can be effective, as shown by the significant increases in serum ferritin levels in the studies. The recommended dosing varies depending on the patient population, but common regimens include:

• 100 mg of Venofer administered at 10 consecutive dialysis sessions
• 200 mg of Venofer over 2 to 5 minutes, 5 times within 14 days
• Two 500 mg infusions on Day 1 and Day 14, administered over 3.5 to 4 hours It is essential to note that these dosing regimens are based on specific patient populations, such as those with hemodialysis-dependent or non-dialysis-dependent chronic kidney disease. Consultation with a healthcare professional is necessary to determine the appropriate dosing regimen for individual patients 2, 2, 2.

From the Research

Increasing Ferritin Levels

To increase ferritin levels, the following methods can be considered:

• Oral iron supplementation, which is the first line of treatment for iron-deficiency anemia and can help replenish iron stores 3, 4
• Taking ferrous sulfate, which is the simplest and most commonly prescribed oral iron supplement 3
• Using novel iron formulations, such as ferric maltol or nanoparticle encapsulated sucrosomial iron, which may have fewer gastrointestinal side effects 3
• Receiving intravenous iron therapy, which can rapidly achieve therapeutic targets without gastrointestinal complications, especially when oral iron supplementation is contraindicated 3, 4

Dosage and Frequency

The optimal dosage and frequency of oral iron supplementation can vary:

• A study found that taking 270 mg of ferrous sulphate every other day was as effective as taking it once or twice a day, with fewer gastrointestinal side effects 5
• Another study suggested that standard treatment with oral ferrous sulfate may not cause a rise in serum ferritin until hemoglobin levels are normal, while double the dose may cause a temporary rise in ferritin levels 6

Important Considerations

It is essential to note that:

• Iron deficiency can be caused by various factors, including bleeding, impaired iron absorption, inadequate dietary iron intake, and pregnancy 4
• Testing for iron deficiency is indicated for patients with anemia and/or symptoms of iron deficiency, and should be considered for those with risk factors such as heavy menstrual bleeding or chronic inflammatory conditions 4