Ferritin: What is it? Normal Values, High Values, Low Values ​​and Associated Conditions

It is a protein found in the cells of most living organisms. It binds to iron and plays an important role in the storage of iron in the human body.

Iron a is an important part of hemoglobin, a protein molecule that carries oxygen in red blood cells and delivers it to the cells of the body. The body depends on iron to make normal amounts of hemoglobin.

Iron stores in the body exist mainly in the form of ferritin. If iron stores are reduced, the body may not be able to make enough hemoglobin to meet the demands of the cells. This will be reflected in low levels of ferritin.

Anemia is generally defined as a decrease in red blood cells or hemoglobin in the blood.

Although low iron levels can cause anemia, too much iron can also cause health problems. Iron overload is a relatively common condition.

What is ferritin?

Ferritin is a protein that stores iron in the body. It is found in virtually all cells and only a relatively small fraction is found circulating in the blood.

The largest amount is found in liver cells and cells of the immune system .

Transferrin is a protein that carries ferritin in the blood. When the body needs more hemoglobin and red blood cells, it will signal cells to release ferritin, which is then carried by transferrin so that iron is available for the production of hemoglobin and red blood cells.

Therefore, the main function of ferritin is to store iron in cells and deliver it safely to the areas where it is required.

Ferritin can be easily measured in blood. The levels correlate with the total amount of iron stored in the body. Therefore, serum ferritin reflects the body’s iron stores.

In general, low levels suggest iron deficiency, while high levels may suggest iron overload in the body. However, elevated levels are often found in the absence of iron overload.

Normal values

Ferritin levels tend to increase with age, and the levels are higher in men than in women.

The reference range is as follows:

  • Men : 23-336 ng / mL.
  • Women: 11-306 ng / mL.

Low ferritin: what does it mean?

Low levels are generally associated with iron deficiency caused by blood loss or lack of iron in the diet.

Common causes of blood loss that lead to low ferritin levels are long-term blood loss due to heavy menstrual bleeding or bleeding from the gastrointestinal tract.

The latter can be the result of ulcers, inflammation, or cancer of the stomach, small intestine, or colon. Sometimes the blood loss can be from hemorrhoids.

Low levels typically reflect iron deficiency anemia, but can also be caused by celiac disease, hypothyroidism, and vitamin C deficiency.

One study showed that low levels, resulting from iron deficiency, were found in 19% of vegetarians.

Common symptoms associated with low levels are:

  • Fatigue.
  • Headache.
  • Dizziness
  • Inexplicable weakness

High ferritin: what does it mean?

In the clinical setting, elevated levels suggest excess iron or an inflammatory reaction in which levels rise without excess iron.

Very high levels can indicate an accumulation of iron in the body. Hemochromatosis is an autosomal recessive genetic disorder of iron metabolism characterized by very high levels of ferritin.

Obesity, inflammation, and daily alcohol consumption can also raise ferritin levels. It can also be elevated in women with anorexia nervosa.

This is most likely due to increased iron storage secondary to the contraction of circulating blood volume and reduced iron losses due to less menstrual bleeding.

Symptoms of excess iron overload can include:

  • Fatigue.
  • Inexplicable weakness
  • Joint pain

If ferritin levels are high, other tests may be done to provide more information about the body’s iron stores.

The most common tests are serum iron and total iron binding capacity (TIBC). The TIBC reflects the level of transferrin.

Transferrin saturation is the ratio of serum iron to TIBC (serum iron / TIBC). Transferrin saturation is high in patients with hereditary hemochromatosis, typically> 45% and sometimes> 55%.

Transferrin saturation

Transferrin saturation can help differentiate between iron overload and other causes of elevated ferritin.

Transferrin saturation is the ratio of serum iron to TIBC (serum iron / TIBC). Transferrin saturation is high in patients with hereditary hemochromatosis, typically> 45% and sometimes> 55%.

Ferritin as an acute phase reagent

Ferritin is also known as an acute phase reactant which implies that when inflammation is present its levels will increase.

Therefore, the levels are often present in patients with infections, some cancers, such as Hodgkin lymphoma and leukemia, and in conditions such as rheumatoid arthritis and systemic lupus erythematosus.

Serum levels are typically elevated in adult Still’s disease, systemic juvenile osteoarthritis, and hematophagocytic lymphohistiocytosis.

Conditions associated with increased ferritin level

Elevated serum ferritin is commonly found in general practice. The first step is to exclude conditions related to iron overload, such as hereditary hemochromatosis. Ninety percent of elevated ferritin is not due to iron overload.

If hereditary hemochromatosis is excluded, the study should aim to identify alcohol use, metabolic syndrome, obesity, liver disease, cancer, infection, or inflammation as causative factors.

Ferritin levels are increased in the following:

  • Acute and chronic liver disease.
  • Infection.
  • Inflammation.
  • Alcoholism.
  • Cancer.
  • Hyperthyroidism
  • Gaucher disease.
  • Iron overload (hemochromatosis).
  • End-stage kidney disease.
  • Anemia other than iron deficiency.

High levels have been associated with metabolic syndrome, hyperinsulinemia, and nonalcoholic fatty liver disease.

In women, ferritin levels rise significantly after menopause and can carry an increased risk of osteoporosis.

Hereditary hemochromatosis

Hereditary hemochromatosis is an autosomal recessive condition of progressive iron overload, commonly caused by the homozygosity of the C282Y mutation in the HFE gene.

The C282Y mutation causes an inappropriate increase in intestinal iron absorption that causes iron overload in the body due to genetic changes that compromise the synthesis or activity of hepcidin, the iron hormone.

Ferritin: Low and High Ferritin Levels Explained

Hereditary hemochromatosis is usually treated by drawing blood from the body (phlebotomy) on a regular basis.

Similar to type 1 diabetes which is a glucose metabolism disorder caused by insulin deficiency, hemochromatosis is a metabolic condition of iron metabolism due to hepcidin deficiency.

About 1 in 200 people are homozygous for the C282Y mutation. The mutation has a higher penetrance than the H6RD mutation.

Hereditary hemochromatosis carries a risk of organ damage due to iron overload, including:

  • Hepatic injury.
  • Liver cirrhosis and liver cancer.
  • Irregular heartbeat (arrhythmia).
  • Heart muscle disorders (cardiomyopathy).
  • Diabetes.
  • Arthritis.
  • Brownish pigmentation of the skin.

The most useful blood tests in evaluating iron overload due to hereditary hemochromatosis are serum ferritin and transferrin saturation.

A transferrin saturation <45% in patients with elevated ferritin makes hereditary hemochromatosis less likely and may suggest other causes.

Hereditary hemochromatosis is usually treated by drawing blood from the body (phlebotomy) on a regular basis.

The goal of phlebotomy is to reduce iron levels to normal levels. Ferritin levels are used to control therapy. It may take a year or more to reduce iron stores to normal levels.