Ferritin, a crucial protein in the human body, serves as the main storage mechanism for iron, reflecting the total iron reserves present. Iron is essential for numerous physiological functions such as oxygen transport and energy metabolism, and it must be carefully balanced to support overall health. Low ferritin levels often indicate low iron levels, which can progress to anemia, whereas high levels may suggest iron overload, potentially leading to conditions like hemochromatosis.
This article aims to provide readers with insights into ferritin level measurement. It will cover the necessity of testing, the procedure involved, and the interpretation of results, helping readers understand how to manage and maintain healthy iron levels effectively.
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What is Ferritin?
Ferritin is important for maintaining healthy iron levels due to its role as an iron storage protein. Iron is an essential mineral involved in many important systemic processes, most notably as a component of hemoglobin in red blood cells, responsible for transporting oxygen throughout the body and delivering it into the tissues.
Minimizes Iron Toxicity
Despite being an important player in overall bodily health and function, excess levels of free iron can lead to the formation of free radicals, which can damage DNA, lipids, and proteins (18). Ferritin helps to manage iron’s potentially toxic effects by storing excess iron so that it is less likely to generate free radicals. The storage capacity of ferritin is not unidirectional, however, and ferritin can make iron available when needed for important bodily functions (18).
Clinical Marker for Iron Stores
As a key regulator of available iron, ferritin is an important clinical marker for measuring total iron body stores, making it a valuable tool in the assessment of iron deficiency and iron overload (18). Serum ferritin is one component of an overall iron panel that includes serum iron, transferrin saturation, and total iron-binding capacity, which is often used in the evaluation of iron deficiency anemia (18). Serum ferritin is often utilized to monitor iron supplementation to help ensure that levels are kept within healthy limits and to protect against iron overload.
Acute Phase Reactant
It is important to note that ferritin is also an acute phase reactant, meaning that its level can rise in the presence of both acute and chronic inflammation. High ferritin levels are often elevated in inflammatory conditions such as autoimmune disease, chronic kidney disease, and malignancy. When ferritin is elevated in these conditions, it can lead to iron deficiencies such as that seen in anemia of chronic disease, due to increased sequestration of iron (26).
Indications for Ferritin Testing
Ferritin testing is important for understanding iron-related conditions, providing insights into iron deficiency and overload situations.
Identifying Iron Deficiency:
Low iron is a common nutrient deficiency that can eventually lead to iron deficiency anemia (IDA) or iron deficiency without anemia (IDWA), which together affect over 2 billion people worldwide (2). IDA and IDWA can cause symptoms such as fatigue, muscle weakness, and shortness of breath. Due to its high sensitivity and specificity, serum ferritin is particularly suited to identify IDWA, even when complete blood cell counts are normal. Serum ferritin is thus an important diagnostic and screening tool for both IDWA and IDA (2).
Monitoring Iron Overload:
Poor absorption or excessive intake of iron can lead to iron overload in the body. This excess iron accumulates and deposits in various organs, including the heart, liver, and joints, where it can cause free radical damage, potentially contributing to conditions like heart issues and liver concerns (18).
Hereditary hemochromatosis (HH) is a genetic condition that results in increased absorption of iron from foods and is an important cause of iron overload. As HH is often managed with routine phlebotomy, serum ferritin is also an important monitoring tool to gauge appropriate phlebotomy frequency to help prevent unintentional low iron levels (18).
Other Medical Conditions:
Serum ferritin can also be used as an indirect marker for:
- Inflammatory disorders
- Cardiovascular health
- Liver health
- Restless Leg Syndrome
- Rheumatoid arthritis
- Coronary artery health
- Hepatitis C
Preparing for the Ferritin Test
To help ensure the accuracy of your ferritin test results, follow these straightforward preparation guidelines.
Pre-Test Instructions:
The preparation for a serum ferritin blood draw is relatively easy. If you are only testing for ferritin, fasting is not necessary, and you can eat normally. You also do not need to avoid taking any medications or supplements you may be on. If ferritin is being tested as part of a larger panel, check with your provider, as fasting and/or medication avoidance may be indicated for other labs (1).
What to Expect During the Test:
Blood draws are performed by healthcare providers and trained phlebotomists. During a blood draw procedure, you will be seated as the provider inspects your arms for a suitable vein usually located in the inner elbow or less commonly in the hand. The provider will then clean the site with an antiseptic and apply a tourniquet to the upper arm to help make the selected vein more prominent. A needle will then be inserted to collect the venous blood into a small tube. After the sample is collected, the tourniquet and needle are removed and the sample is sent to the laboratory to be processed (5).
Understanding Ferritin Test Results
Normal
Generally, normal ranges for ferritin fall between 30-400 ng/mL in men and 15-150 ng/mL in women, though this may vary slightly from lab to lab. Anything above this range is considered high, and anything below is considered low.
High
High ferritin levels can be associated with:
- Inflammation
- Obesity
- Excessive alcohol intake
- Hemochromatosis
- Liver health issues
Low
Low serum ferritin can be associated with:
- Iron deficiency anemia
- Iron deficiency anemia without iron
- Hypothyroidism
- Vitamin C deficiency
- Celiac disease
- Crohn’s disease
Although the normal range for serum ferritin is above 15 ng/mL in women and 30 ng/mL in men, some sources suggest that 40 ng/mL be the lower cutoff when screening for iron deficiency and that therapeutic targets be set as high as 100 ng/mL (2, 18).
Other Factors Influencing Ferritin Levels
Other non-pathological causes can lead to altered ferritin levels. These primarily include genetic mutations of the hemochromatosis gene that affect iron absorption but not to the level of hereditary hemochromatosis. These mutations can cause either high ferritin levels or reduced ferritin levels depending on their expression (24).
Follow-up and Management
If your ferritin lab tests come back abnormal, your healthcare provider will likely perform additional testing and workup to identify the cause. This may include further blood work, imaging, or genetic testing, depending on the suspected issue. Treatment plans will then be determined based on the root cause of the issue.
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Key Takeaways
- Ferritin plays a vital role in assessing iron status, serving as a primary storage protein for iron and an indicator of both iron deficiency and overload. It’s important for understanding conditions like iron deficiency anemia and hereditary hemochromatosis.
- Elevated ferritin levels can signal not just iron overload but also acute or chronic inflammation, impacting conditions like autoimmune diseases and cardiovascular health.
- Accurate ferritin testing is key to guiding effective management strategies. It helps ensure iron levels are maintained within a healthy range, avoiding both deficiency and excess.
- Due to its complexity, interpreting ferritin levels should be done by healthcare professionals. This ensures the development of an appropriate management plan based on individual patient needs, incorporating diet, lifestyle, or medical interventions as required.
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