Ferritin

Anemia

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No Fasting Required

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Reflects iron stores; low in iron deficiency anemia, high in chronic inflammation or hemochromatosis.

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Ferritin Test Information Guide

Why is it done?
- Measures iron storage in the body and reflects total iron stores. Ferritin is a protein that binds iron and protects tissues from iron-induced damage.
- Diagnose iron deficiency anemia when combined with other iron studies (serum iron, transferrin saturation, TIBC).
- Detect iron overload conditions such as hemochromatosis, repeated blood transfusions, or chronic liver disease.
- Monitor iron status in patients with chronic kidney disease, heart failure, or inflammatory conditions.
- Assess patients with unexplained fatigue, weakness, or joint pain.
- Screen family members of patients with hereditary hemochromatosis.
- Monitor response to iron supplementation or phlebotomy treatment.
Normal Range
- Normal ferritin levels (typical ranges):
- Adult males: 30-400 ng/mL (nanograms per milliliter)
- Adult females: 15-200 ng/mL
- Children: varies by age, typically 7-142 ng/mL
- Note: Reference ranges may vary between laboratories; always refer to the specific lab's reference values.
- Low ferritin (<15-30 ng/mL): Indicates iron deficiency; may represent depleted iron stores or iron deficiency anemia.
- Normal ferritin: Suggests adequate iron stores.
- High ferritin (>200-400 ng/mL): May indicate iron overload, hemochromatosis, liver disease, or inflammation. Requires further investigation.
Interpretation
- Low Ferritin (<15 ng/mL):
- Indicates depleted iron stores (iron deficiency stage 1). May precede iron deficiency anemia.
- Common causes: inadequate dietary iron intake, chronic blood loss, malabsorption disorders, pregnancy.
- High Ferritin (>200-400 ng/mL):
- May indicate iron overload disorders, chronic hemolysis, or secondary iron accumulation.
- Important: High ferritin is NOT specific for iron overload; it is an acute phase reactant and can be elevated in inflammation, infection, malignancy, liver disease, and metabolic syndrome.
- Borderline Results:
- Ferritin 15-30 ng/mL or 200-300 ng/mL may require additional iron studies (serum iron, TIBC, transferrin saturation) and clinical correlation.
- Factors Affecting Results:
- Inflammation: Elevates ferritin independent of iron status (C-reactive protein, ESR helpful to identify)
- Infection and fever: Acute phase response increases ferritin
- Liver disease: Impairs iron metabolism and ferritin clearance
- Malignancy: Can elevate ferritin levels
- Gender and age: Women typically have lower levels due to menstrual blood loss
- Recent transfusions: Artificially raise ferritin levels
Associated Organs
- Primary Organ System:
- Bone marrow: Site of red blood cell production; affected by iron deficiency anemia
- Liver: Primary site of ferritin synthesis and iron storage; affected in iron overload conditions
- Gastrointestinal tract: Absorption site for dietary iron
- Diseases and Conditions Associated with Abnormal Ferritin:
- Low ferritin: Iron deficiency anemia, celiac disease, Crohn's disease, chronic GI bleeding, severe malnutrition
- High ferritin: Hereditary hemochromatosis, transfusional iron overload (thalassemia, sickle cell disease), secondary hemochromatosis, cirrhosis, hepatitis, fatty liver disease
- Inflammatory/autoimmune diseases: Rheumatoid arthritis, lupus, inflammatory bowel disease
- Metabolic disorders: Type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease
- Potential Complications of Abnormal Iron Status:
- Iron deficiency: Fatigue, weakness, reduced cognitive function, impaired immune function, poor wound healing
- Iron overload: Cirrhosis, hepatocellular carcinoma, cardiomyopathy, arrhythmias, diabetes, joint damage, pituitary dysfunction
Follow-up Tests
- Recommended Additional Iron Studies:
- Serum iron: Measures circulating iron; often low with iron deficiency, high with overload
- Total iron binding capacity (TIBC): Measures transferrin; elevated in iron deficiency
- Transferrin saturation: Calculated ratio of serum iron/TIBC; >45% suggests iron overload, <20% suggests deficiency
- Soluble transferrin receptor: More specific for iron deficiency, not affected by inflammation
- Tests for Iron Deficiency Diagnosis:
- Complete blood count (CBC): Evaluates hemoglobin, hematocrit, MCV for anemia signs
- Peripheral blood smear: Shows microcytic, hypochromic RBCs typical of iron deficiency
- Tests for Iron Overload Investigation:
- HFE gene testing: To confirm hereditary hemochromatosis (HFE C282Y mutation)
- Liver function tests: AST, ALT, bilirubin to assess liver damage
- MRI or CT of liver: Quantifies hepatic iron content in suspected hemochromatosis
- Tests for Inflammatory Causes:
- C-reactive protein (CRP): Elevated in inflammation; helps distinguish inflammation from iron overload
- Erythrocyte sedimentation rate (ESR): Another marker of inflammation
- Monitoring Frequency:
- Iron deficiency treatment: Repeat ferritin in 4-12 weeks after starting iron therapy
- Hemochromatosis management: Monitor ferritin every 3-6 months during phlebotomy, then 1-2 times yearly
- Transfusion-dependent patients: Monitor ferritin regularly (typically every 3 months) to assess iron burden
Fasting Required?
- No - Fasting is NOT required for ferritin testing.
- Patient Preparation:
- No special dietary restrictions; patient may eat and drink normally before the test
- Blood draw can be performed at any time of day
- Mild exercise or physical activity should be avoided 24 hours prior to testing, if possible, as it may affect iron levels
- Medications:
- Iron supplements: Should be continued as prescribed unless otherwise instructed; inform the lab if taking iron therapy
- No medications need to be avoided specifically for ferritin testing
- Inform healthcare provider of recent infections, inflammation, or fevers, as these can temporarily elevate ferritin
- Additional Instructions:
- Report any recent blood transfusions to the lab technician or healthcare provider
- Wear loose, comfortable clothing with sleeves that can be easily rolled up
- Stay hydrated; drink water before the blood draw to aid in vein visibility

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