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

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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)

• Adult-Onset Still’s Disease (see Adult-Onset Still’s Disease, [[Adult-Onset Stills Disease]])
• Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis, [[Rheumatoid Arthritis]])
• Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus, [[Systemic Lupus Erythematosus]]): elevated ferritin correlates with disease activity
• Polydermatomyositis (see Polydermatomyositis, [[Polydermatomyositis]])
• Multiple Sclerosis (see Multiple Sclerosis, [[Multiple Sclerosis]])

Hematologic

• Hemosiderosis: due to repeated PRBC transfusion
  • Median Ferritin Level: 1977 ug/L
• Hemophagocytic Syndrome (see Hemophagocytic Syndrome, [[Hemophagocytic Syndrome]])
• Porphyria Cutanea Tarda (see Porphyria Cutanea Tarda, [[Porphyria Cutanea Tarda]])
• Sideroblastic Anemia (see Sideroblastic Anemia, [[Sideroblastic Anemia]])
• Thalassemia (see Thalassemia, [[Thalassemia]])

Neoplasm

(median ferritin level: 1767 ug/L)

• Neuroblastoma
• Lymphoma (see Lymphoma, [[Lymphoma]])
• Leukemia (see Acute Myeloid Leukemia [[Acute Myeloid Leukemia]] and Acute Lymphocytic Leukemia, [[Acute Lymphocytic Leukemia]])
• Breast Cancer (see Breast Cancer, [[Breast Cancer]])

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

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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