Synonym

Serum ferritin level

Tubes

• Red, tiger top, or gel barrier tube
• 5 mL of venous blood

Additional information

• Handle sample gently to prevent hemolysis

Info

• The serum ferritin level is a test that is an indicator of iron body stores
• Ferritin is the primary storage molecule for iron, with 70-80% of iron being stored in the form of ferritin, with smaller amounts stored as hemosiderin
• Ferritin originates from reticuloendothelial cells of the liver, spleen, and erythroblasts of bone marrow
• Ferritin has an outer protein shell of apoferritin and a central core of iron in the ferric form existing as heterogeneous ferric oxyhydroxide micelles with some phosphate
• In healthy individuals, serum ferritin reflects body iron stores, and is the most reliable indicator of total body iron status

Clinical

• The clinical utility of ferritin measurement includes:
• In the evaluation of iron deficiency anemia
• Evaluation of efficacy of oral iron therapy
• To differentiate anemia of chronic disease from iron deficiency anemia
• To monitor the iron status in chronic renal disease patients
• Detection of iron overload and to monitor rate of iron accumulation (e.g. Hemochromatosis)
• To monitor the response to iron chelation therapy in iron overload
• To determine the iron status of a population and response to iron fortification

• Decreased iron levels as in iron deficiency anemia may clinically present as
• Fatigue and weakness
• Pale skin
• Tachycardia
• Shortness of breath
• Chest pain
• Dizziness
• Syncope
• Cognitive problems
• Numbness or coldness of extremities
• Headache
• Inflammation or soreness of tongue
• Brittle nails
• Unusual cravings for non-nutritive substances, such as ice, dirt or pure starch
• Poor appetite in infants and children
• Iron overload, as in hemochromatosis, can present with nonspecific symptoms at the early stage of the disease, which includes:
• Fatigue
• Weakness
• Weight loss
• Abdominal pain
• Joint pain
• Loss of menstrual periods or early menopause
• Loss of libido or impotence
• Loss of body hair
• Shortness of breath
• Advanced stages of hemochromatosis may result in:
• Heart: Cardiomyopathy, conduction disturbances
• Liver: Abdominal pain, elevated liver chemistries, hepatomegaly, cirrhosis, hepatocellular carcinoma
• Skin: Bronzing (melanin deposition), gray pigmentation (iron deposition)
• Infection: Vibrio vulnificus, Listeria monocytogenes, Pasteurella pseudotuberculosis
• Pituitary gland: Gonadotropin insufficiency leading to secondary hypogonadism
• Pancreas: Diabetes mellitus
• Thyroid gland: Hypothyroidism
• Genitalia: Primary hypogonadism
• Joints: Arthropathy in metacarpophalangeal joints, pseudogout
• Compared to iron and total iron-binding capacity, serum ferritin is a more sensitive and specific test for diagnosing iron deficiency anemia
• Elevated ferritin levels should be interpreted with caution as they may increase in inflammatory conditions (it is also an acute phase reactant protein)
• Elevated ferritin level is considered a risk factor for primary hepatocellular carcinoma

Additional information

• Total iron stores are 0.7-1.5 grams, and 1.0 ng/mL of serum ferritin is equivalent to 8 mg of storage iron
• Limitations of the ferritin assay include
• Ferritin determination is not reliable in infants with iron therapy
• It is not of value to evaluate iron stores in alcoholic persons with liver disease
• In certain conditions such as rheumatoid arthritis and malignancy, iron deficiency may not be reflected by low serum ferritin
• Factors interfering with test results include:
• Radioactive scans within 3 days before test
• Blood transfusion with in the past 4 months (false high levels)
• Female athlete involved in high performance sports that alters the menstrual cycle
• Diet high in red meats
• Recent severe illness or surgery
• Old age (higher values)
• Hemolyzed specimens
• Related laboratory tests include:
• Bone marrow biopsy
• Transferrin
• Complete blood count
• Erythropoietin
• Hematocrit
• Hemoglobin
• Iron/total iron-binding capacity
• Liver biopsy
• Platelet count
• Red blood cell count
• Red blood cell indices
• Red blood cell morphology and inclusions

Nl Result

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

High Result

Elevated serum ferritin (> 400 ng/mL or > 400 µg/L) occurs in iron excess which includes:

• Iron overload
• Hemochromatosis
• Hemosiderosis
• Oral or parenteral iron administration
• Inflammatory diseases
• Acute or chronic liver disease
• Malignancies
• Acute myoblastic leukemia
• Acute lymphoblastic leukemia
• Hodgkin's disease
• Breast carcinoma
• Lymphoma
• Hyperthyroidism
• Hemolytic anemia
• Megaloblastic anemia
• Thalassemia
• Sideroblastic anemia
• Gaucher’s Disease
• Renal cell carcinoma
• End-stage renal disease
• Stills’s disease
• Neuroblastoma
• Fasting
• Drugs
• Ferrous sulfate
• Ethanol
• Ferric polymaltose
• Iron preparations
• Oral contraceptives
• Theophylline

Low Result

Conditions associated with decreased ferritin levels include:

• Iron deficiency anemia
• Hemodialysis
• Chronic gastrointestinal bleeding
• Heavy menstrual bleeding
• Drugs
• Antithyroid therapy
• Ascorbic acid
• Erythropoietin
• Deferoxamine
• Methimazole

References

• Acton RT et al. Relationships of serum ferritin, transferrin saturation, and HFE mutations and self-reported diabetes in the Hemochromatosis and Iron Overload Screening (HEIRS) study. Diabetes care. 2006 Sep;29(9):2084-9
• El-Khatib M et al. Role of C-reactive protein, reticulocyte haemoglobin content and inflammatory markers in iron and erythropoietin administration in dialysis patients. Nephrology (Carlton). 2006 Oct;11(5):400-4
• Hearnshaw S et al. The epidemiology of hyperferritinaemia. World J Gastroenterol. 2006 Sep 28;12(36):5866-9
• Laboratory Corporation of America. Ferritin, Serum. [Homepage on the internet]©2007. Last accessed on April 24, 2007. Available at URL: http://www.labcorp.com/datasets/labcorp/html/chapter/mono/ri020300.htm
• LabTestsOnline®. Ferritin. [Homepage on the Internet]© 2001-2006. Last reviewed on March 10, 2006. Last accessed on December 6, 2006. Available at URL: http://www.labtestsonline.org/understanding/analytes/ferritin/test.html
• Laine F et al. Effects of phlebotomy therapy on cytochrome P450 2e1 activity and oxidative stress markers in dysmetabolic iron overload syndrome: a randomized trial. Aliment Pharmacol Ther. 2006 Oct 15;24(8):1207-13
• Mtvarelidze Z et al. [DAMAGE OF IRON METABOLISM AND OXIDOREDUCTION PROCESS IN CHILDREN WITH beta-THALASSEMIA.] [Article in Russian]. Georgian Med News. 2006 Jul;(136):69-71
• UTMB Laboratory Survival Guide®. FERRITIN, serum. [Homepage on the Internet]© 2006. Last reviewed in February 2006. Last accessed on December 6, 2006. Available at URL: http://www.utmb.edu/lsg/LabSurvivalGuide/CHEM/FERRITIN.html
• Voss P et al. Ferritin oxidation and proteasomal degradation: protection by antioxidants. Free Radic Res. 2006 Jul;40(7):673-83
• Zaleska M et al. [The significance of the serum tumour markers as a prognostic and predictor factors in nonsmall cell lung cancer patients] [Article in Polish]. Pneumonol Alergol Pol. 2005;73(3):270-6