Hyperferritinemia

Ferritin Testing

  • Avoid ferritin testing during acute ilness -> as it is an acute phase reactant, may be elevated due to acute illness alone
    • Serum transferrin saturation (iron/TIBC ratio) falls during acute illness and -> this may mask the presence of iron overload
    • If a high transferrin saturation is unexplained, a fasting sample may be useful as iron saturation can be affected by a high iron meal

Etiology

Hepatic

  • Hereditary Hemochromatosis (see Hereditary Hemochromatosis, [[Hereditary Hemochromatosis]])
    • Median Ferritin Level: 5031 ug/L
    • Iron/TIBC Ratio (ie: transferrin saturation): most sensitive test to determine if elevated ferritin is due to hemochromatosis-related iron overload
      • Transferrin saturation of >60% in males and >50% in females: sensitivity of >90% for iron overload
      • If transferrin saturation is elevated on more than one occasion, then testing for the common mutations of the HFE gene is indicated in Caucasian patients
  • Alcoholic Liver Disease (see Alcoholic Liver Disease, [[Alcoholic Liver Disease]])
    • Median Ferritin Level: 2484 ug/L
  • Hepatic Steatosis/Fatty Liver (see Hepatic Steatosis, [[Hepatic Steatosis]])
  • Non-Alcoholic Steatohepatitis (see Non-Alcoholic Steatohepatitis [[Non-Alcoholic Steatohepatitis]])
  • Viral Hepatitis (see Hepatitis C Virus, [[Hepatitis C Virus]])
  • Wilson’s Disease (see Wilsons Disease, [[Wilsons Disease]])

Autoimmune

(median Ferritin Level: 2203 ug/L)

Hematologic

Neoplasm

(median ferritin level: 1767 ug/L)

Inflammation/Infection

  • Inflammatory Bowel Disease (see Inflammatory Bowel Disease, [[Inflammatory Bowel Disease]])
  • Bacterial Infections
    • Median Ferritin Level: usually around 2000 ug/L
  • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Median Ferritin Level: 1711 ug/L

Other

  • Dialysis-Dependent Renal Failure (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
    • Median Ferritin Level: 1975 ug/L
  • Hyperthyroidism (see Hyperthyroidism, [[Hyperthyroidism]])
  • Weight Loss: >10% decrease in BMI in last 6 months
    • Median Ferritin Level: 2508 ug/L
    • Types
      • Anorexia Nervosa
  • Heavy Exercise: as in the case of ultramarathon running, etc
  • Familial Hyperferritinemia and Cataract Syndrome
  • Idiopathic Hyperferritinemia

References

  • The epidemiology of hyperferritinemia. World J Gastroenterol 2006; 12(36): 5866-5869
  • Hyperferritinemia in autoimmunity. Isr Med Assoc J. 2008 Jan;10(1):83-4