section name header

Introduction ⬇

Ferritin, a complex of ferric (Fe2+) hydroxide and a protein, apoferritin, originates in the reticuloendothelial system. Ferritin reflects the body iron stores and is the most reliable indicator of total-body iron status. A bone marrow examination is the only better test. Bone marrow aspiration may be necessary in some cases, such as low-normal ferritin and low serum iron in the anemia of chronic disease.

The ferritin test is more specific and more sensitive than iron concentration or TIBC for diagnosing iron deficiency. Ferritin decreases before anemia and other changes occur (see Table 2.6).

Normal Findings ⬆ ⬇

Men: 18–270 ng/mL or 18–270 μg/L

Women: 18–160 ng/mL or 18–160 μg/L

Children: 7–140 ng/mL or 7–140 μg/L

Newborns: 25–200 ng/mL or 25–200 μg/L

Clinical Alert

Critical ValueIron deficiency: 10 ng/mL or 10 g/L

Procedure ⬆ ⬇

  1. Obtain a venous sample of 6 mL using a red-topped tube or SST. Label the specimen with the patient’s name, date and time of collection, and test(s) ordered.

  2. Place the specimen in a biohazard bag.

Clinical Implications ⬆ ⬇

  1. Decreased ferritin (<10 ng/mL or <10 μg/L) usually indicates iron-deficiency anemia.

  2. Increased ferritin (>400 ng/mL or >400 μg/L) occurs in iron excess and in the following:

    • Iron overload from hemochromatosis or hemosiderosis

    • Oral or parenteral iron administration

    • Inflammatory diseases

    • Acute or chronic liver disease involving alcoholism

    • Acute myoblastic or lymphoblastic leukemia

    • Other malignancies (Hodgkin disease, breast carcinoma, malignant lymphoma)

    • Hyperthyroidism

    • Hemolytic anemia, megaloblastic anemia, thalassemia, sideroblastic anemia

    • Renal cell carcinoma, end-stage renal disease

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain test purpose and procedure. Fasting is not necessary. Assess for signs/symptoms of dyspnea; fatigue; listlessness; pallor; loss of consciousness; irritability; headache; tachycardia; brittle, spoon-shaped nails; and cracks at the corners of the mouth.

  2. Radioactive medications may not be given for 3–4 days before testing.

  3. Refrain from alcohol (higher levels of ferritin occur in alcoholism).

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Have the patient resume normal activities.

  2. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient regarding abnormal findings; explain the need for possible follow-up testing and treatment. Monitor for iron-deficiency anemia and ferritin increases. When iron and TIBC tests are used together with ferritin, they can better distinguish between iron-deficiency anemia and the anemia of chronic disease. Treatment may include VB12 and folic acid.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆

  1. Recently administered radioactive medications cause spurious results.

  2. Oral contraceptives and antithyroid therapy interfere with testing (see Appendix E).

  3. Hemolyzed blood may cause high results.

  4. Increases with age.

  5. Higher in red meat eaters than in vegetarians.

  6. Ferritin is not of value to evaluate iron stores in persons with alcoholism who have liver disease.