From the Guidelines
New onset of ferritin levels over 1000 ng/mL is typically caused by several conditions including iron overload disorders, inflammatory conditions, liver disease, and certain cancers. The most common causes of hyperferritinemia include chronic alcohol consumption, inflammation, cell necrosis, tumors, and non-alcoholic fatty liver disease (NAFLD) and/or the metabolic syndrome 1. In patients presenting with increased serum ferritin concentrations, it is mandatory to search for common causes of hyperferritinemia before genetic tests are carried out 1. Some key conditions that can lead to elevated ferritin levels include:
- Hereditary hemochromatosis, a genetic disorder causing excessive iron absorption
- Inflammatory conditions like rheumatoid arthritis, systemic lupus erythematosus, and adult-onset Still's disease
- Liver diseases such as alcoholic liver disease, viral hepatitis, and non-alcoholic fatty liver disease
- Malignancies, particularly leukemia, lymphoma, and hepatocellular carcinoma
- Frequent blood transfusions, hemolytic anemias, and metabolic syndrome
- Certain medications and excessive alcohol consumption When ferritin exceeds 1000 ng/mL, it's essential to conduct a thorough evaluation including complete blood count, liver function tests, iron studies, and potentially genetic testing for hemochromatosis to determine the underlying cause and guide appropriate treatment 1. In the presence of biochemical evidence of inflammation, the lower limit of ferritin consistent with normal iron stores should therefore be increased to 100 μg/L, and hypoferraemia should be considered likely if TfS is below 16% and serum ferritin is between 30 and 100 g/L 1. A more specific diagnostic marker than ferritin may be its glycosylated fraction, which is often less than 20% in adult-onset Still's disease 1. It is crucial to identify the underlying cause of elevated ferritin levels to provide appropriate treatment and prevent long-term complications.
From the Research
Causes of Elevated Ferritin Levels
The causes of new onset of ferritin levels over 1000 can be varied and include:
- Malignancy: According to 2, malignancy is the most frequent condition associated with elevated ferritin levels, with 153 out of 627 patients having this condition.
- Iron-overload syndromes: Iron-overload syndromes, such as hereditary hemochromatosis, are also a common cause of elevated ferritin levels, with 136 out of 627 patients having this condition 2.
- Inflammatory conditions: Inflammatory conditions, such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome, can also cause elevated ferritin levels, although these conditions are less common 2.
- Anemia of chronic inflammation: Anemia of chronic inflammation can also lead to elevated ferritin levels, with 7 patients out of 627 having this condition 2.
- Other conditions: Other conditions, such as infection, can also cause elevated ferritin levels, although the exact cause may not always be clearly definable 2.
Specific Conditions Associated with Elevated Ferritin Levels
Some specific conditions associated with elevated ferritin levels include:
- Hereditary hemochromatosis: This is a genetic disorder that can lead to iron overload and elevated ferritin levels 3, 4, 5, 6.
- HFE-related hereditary hemochromatosis: This is a specific type of hereditary hemochromatosis that is associated with mutations in the HFE gene 4, 5.
- Hemophagocytic lymphohistiocytosis/macrophage activation syndrome: This is a rare condition that can cause elevated ferritin levels, although it is less common than other conditions such as malignancy and iron-overload syndromes 2.