Differential Diagnosis for Elevated Ferritin, Low Iron Saturation, and Low Iron Level
When ferritin is high, iron saturation is low, and iron level is low, several conditions can be suspected. The differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Anemia of Chronic Disease (ACD): This condition is characterized by elevated ferritin levels due to inflammation, low iron saturation, and low iron levels. The body retains iron within the macrophages, making it unavailable for erythropoiesis, despite adequate iron stores.
Other Likely Diagnoses
- Chronic Inflammatory Conditions (e.g., Rheumatoid Arthritis, Chronic Infections): Similar to ACD, these conditions lead to increased ferritin due to inflammation and can cause low iron saturation and levels due to the body's inflammatory response.
- Obesity: Obesity is associated with chronic inflammation, which can lead to elevated ferritin levels. Additionally, obesity can lead to a state of chronic inflammation, affecting iron metabolism and leading to low iron saturation and levels.
Do Not Miss Diagnoses
- Hemophagocytic Lymphohistiocytosis (HLH): Although rare, HLH is a life-threatening condition that can present with elevated ferritin levels (>500 ng/mL), low iron saturation, and low iron levels. It is crucial to consider HLH due to its high mortality rate if left untreated.
- Malignancies (e.g., Lymphoma, Leukemia): Certain malignancies can cause elevated ferritin levels and disrupt iron metabolism, leading to low iron saturation and levels.
Rare Diagnoses
- Hereditary Hemochromatosis with Inflammation: While hereditary hemochromatosis typically presents with high iron saturation, the presence of inflammation can lead to elevated ferritin and low iron saturation and levels.
- Porphyria Cutanea Tarda: This rare disorder can cause elevated ferritin levels and affect iron metabolism, although it is less commonly associated with the described iron profile.