- Red, tiger top, or gel barrier tube
- 5 mL of venous blood
Additional information
- Handle sample gently to prevent hemolysis
- 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
- 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
Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.
| Conv. Units (ng/mL) | SI Units (µg/L) | |
|---|---|---|
| Adults | ||
| Men | 20-300 | 20-300 |
| Women | 20-200 | 20-200 |
| Borderline (Fe defic) | 10-20 | 10-20 |
| Fe deficiency | < 10 | < 10 |
| Iron overload | > 400 | > 400 |
| Pediatrics | ||
| Newborn | 25-200 | 25-200 |
| Children | 7-140 | 7-140 |
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
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
- 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