Ferritin is an important storage vessel for iron in the body. Healthcare providers frequently use ferritin to assess iron levels in the body. Low iron levels can contribute to anemia, especially iron deficiency anemia. Elevated iron levels in the blood can be associated with several conditions.
This article discusses the importance of ferritin level, its meaning, and when to seek evaluation and treatment for conditions related to ferritin.
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Understanding Ferritin and Its Role
Ferritin is a protein that binds iron to prevent it from being toxic to the body. It helps to regulate iron within the body by releasing it when it’s needed.[9] The ferritin level can be seen as an indication of stored iron in the body.[2] Ferritin plays several roles in iron regulation. [9,13,18]
- Balancing iron levels in the bloodstream: Ferritin holds onto iron and releases it into the body when and where it is needed. This occurs through sequestration, where iron is stored in an inactive form in the core of the ferritin protein.
- Prevention of toxicity: Iron can react with DNA and other proteins in the body, causing damage. Ferritin binds iron, rendering it nontoxic.
- Iron recycling: Ferritin helps recycle iron released through the breakdown of red blood cells.
The normal value for ferritin levels varies based on sex and age. [7]
- Adult males: 24–336 nanograms per milliliter (ng/mL)
- Adult females: 24–307 ng/mL
- Newborns: 25–200 ng/mL
- 1 month old: 200–600 ng/mL
- 2–5 months old: 50–200 ng/mL
- Children 6 months–15 years: 7–140 ng/mL
What is Considered a High Ferritin Level?
Low ferritin levels can indicate iron deficiency, leading to anemia. Elevated ferritin levels can be an indicator of other medical conditions. The degree of high ferritin elevation can determine whether intervention is necessary.[11]
- Levels under 400ng/ml rarely require further investigation or intervention
- Mild elevations of 400-600ng/ml are usually an inflammatory response called an acute phase reaction
- Significant elevations of over 600ng/ml may be an indication of iron overload
- Severe elevations over 1000ng/ml usually require a referral to a specialist
If ferritin levels are too high, it can cause damage to other organs and can sometimes be associated with worse outcomes in people with liver disease.[17]
What Does High Ferritin Mean?
High ferritin levels can indicate many conditions ranging from inflammation to iron overload. Some conditions that cause elevated ferritin levels related to inflammation include:[4,8]
- Liver disease
- Autoimmune conditions such as rheumatoid arthritis
- Hyperthyroidism
- Some types of cancer
- Alcohol use disorder
- Obesity
- Some types of infection
Hemochromatosis is another condition associated with high ferritin levels, where the body absorbs and stores too much iron.[6,8] Blood transfusion can also be a cause of iron overload.[14]
Other lab tests may be necessary to differentiate between inflammatory conditions and iron overload conditions, such as transferrin, iron saturation, and total iron binding capacity.[20,15] Medical history and physical examination may also help determine the cause of the elevated ferritin.
Symptoms and Effects of High Ferritin Levels
The symptoms of high ferritin levels vary with the cause of the elevation. Symptoms associated with hemochromatosis usually start between age 30 and 60 and include[5,16]:
- Fatigue
- Unexplained weight loss
- Joint pain
- Menstrual problems
- Erectile dysfunction
- Brain fog
- Mood swings
- Depression and anxiety
- Abdominal pain
- Changes in skin color
Untreated iron overload associated with high ferritin levels can have several long-term health implications:[10]
- Liver damage - Since iron is stored in the liver, damage to the liver can occur, causing conditions such as scarring, enlargement of the liver, liver failure, and liver cancer.
- Heart problems: Iron overload can cause irregular heart rhythms and heart failure.
- Other: It can also lead to diabetes, arthritis, problems with other organs such as the spleen, adrenal glands, pituitary gland, gallbladder, and thyroid.
- Premature menopause or erectile dysfunction.
- Death (in extreme cases)
How Providers Diagnose High Ferritin Levels
Ferritin can be easily tested in bloodwork. No special preparation is required to have a ferritin level checked, but staying well hydrated can make it easier to get your blood drawn.
Additional lab testing may be needed to help differentiate the cause of the elevated ferritin. These tests include[12]:
- Serum iron levels: a measure of the total amount of iron in the blood
- Transferrin levels: measures the level of a protein that is responsible for iron transport
- Total iron-binding capacity (TIBC): measures the amount of iron attached to proteins in the blood
- C-reactive protein (CRP): a marker of inflammation
- Genetic testing: hemochromatosis is a genetic condition that is associated with the HFE gene. If there is a family history or concern for hemochromatosis, this may be indicated.[1]
Other testing may be necessary to evaluate complications of high ferritin, such as liver disease. Sometimes, an ultrasound or MRI may be necessary.
How Providers Interpret Lab Results
Lab tests should be interpreted with caution and with the assistance of a healthcare provider. They must be considered in conjunction with other clinical indicators, such as symptoms, family history, and physical exam findings.
Often, the full clinical picture may require additional testing or referral to a specialist. Severely elevated ferritin levels usually warrant an evaluation by a specialist. Often, this will be either a hematology/oncology doctor or a gastroenterologist specializing in liver conditions.
How Providers May Treat High Ferritin Levels
The treatment of high ferritin depends on the underlying cause of the lab abnormality. For some people, lifestyle changes may be sufficient, while others require more aggressive treatment.
- Lifestyle changes for iron overload include avoiding foods and supplements that increase iron absorption. Many multivitamins contain iron. Vitamin C can increase iron absorption and may need to be avoided in patients with iron overload.[1]
- Regular follow-up with your healthcare provider can help monitor the condition and its possible complications.
- Underlying inflammatory conditions should be managed as recommended by your healthcare provider.
- Other treatments for elevated ferritin levels include[3]:
- Phlebotomy: regular blood draws can remove excess iron from the body
- Chelation therapy: used in patients who cannot have regular phlebotomy (such as people with underlying anemia). Medications like deferoxamine, deferiprone, and deferasirox may be used to remove iron.[19]
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Key Takeaways
- Ferritin plays a key role in iron balance
- Low ferritin levels can be a sign of iron deficiency
- High ferritin is associated with inflammation and iron overload
- Untreated, high ferritin can lead to organ damage and death
- Ferritin can be easily checked with a lab test
- Elevated ferritin levels can be treated using several different options
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