From the Guidelines
High ferritin with low iron and low transferrin suggests iron sequestration syndrome, most commonly seen in anemia of chronic disease or inflammation, and the most recent and highest quality study 1 supports this diagnosis. This pattern occurs when the body stores iron in tissues rather than using it for red blood cell production. You should consult with a healthcare provider for proper diagnosis and treatment. Initial management typically includes identifying and treating the underlying cause, which could be chronic infection, autoimmune disease, liver disease, or malignancy. Laboratory tests including complete blood count, comprehensive metabolic panel, and inflammatory markers (CRP, ESR) are usually needed.
- The diagnosis of iron deficiency may also be complicated by the fact that iron deficiency and the anaemia of chronic disease frequently coexist and interact in a complex manner, so that a reliable differentiation using laboratory methods may be impossible 1.
- Unlike iron deficiency anemia, iron supplementation is generally not recommended as the problem isn't lack of iron but rather improper utilization.
- Treatment focuses on the underlying condition - for example, anti-inflammatory medications for autoimmune diseases or antimicrobials for chronic infections.
- In some cases, erythropoiesis-stimulating agents may be prescribed to boost red blood cell production, as seen in the management of anemia in patients with congestive heart failure 1.
- This pattern can also occur in hereditary hemochromatosis in early stages, so genetic testing might be considered, especially with family history of iron overload disorders.
- The evaluation of anaemia in any given patient is always incomplete if the inflammatory status is not clearly defined, and measurements of inflammatory parameters that are independent of iron metabolism (ESR, CRP) should be carried out to aid diagnosis 1.
From the Research
High Ferritin, Low Iron, Low Transferrin
- High serum ferritin levels can be associated with inflammation, as seen in patients with chronic kidney disease 2.
- In cases of high ferritin and low iron saturation, inflammation may be a contributing factor, rather than iron overload 2.
- A study found that patients with high ferritin and low transferrin saturation had higher odds of having elevated C-reactive protein levels, indicating inflammation 2.
- The combination of high ferritin and low transferrin saturation can pose a diagnostic dilemma, as it may not accurately reflect iron status 3.
- In some cases, high ferritin levels may be due to autoimmune hepatitis, which can be misdiagnosed as iron overload syndrome 3.
Diagnostic Challenges
- Ferritin is not always a reliable marker of iron status, as it can be elevated in inflammation and other conditions 4, 5.
- The use of ferritin as a diagnostic test for iron deficiency and overload has limitations, particularly in the presence of inflammation 5.
- A study found that the serum ferritin/C-reactive protein ratio may be a useful biomarker for diagnosing iron deficiency in the context of systemic inflammation 6.
Treatment and Management
- In patients with high ferritin and low transferrin saturation, treatment with intravenous iron may be effective in improving hemoglobin levels, but the response to treatment can be variable 4.
- The use of ferritin and other markers to guide treatment decisions in patients with iron deficiency and inflammation requires careful consideration of the underlying clinical context 4, 6.