Causes of high and low ferritin in blood

Results of the ferritin test may be false positive or false negative in inflammation (ferritin is an acute phase protein), tumors, liver pathology, when the ferritin content may be increased. In some cases, patients on hemodialysis have a paradoxically elevated ferritin level with iron accumulation in the cells of the reticuloendothelial system. At the same time, there may be a simultaneous iron deficiency in the bone marrow. Therefore, when assessing iron metabolism, complex studies should be carried out.

A negative iron balance over a long period of time leads to the development of iron deficiency. There are three stages of deficiency, leading to the most severe form - iron deficiency anemia. The signs and symptoms of the disease in the patient also progress, depending on the presence and degree of anemia.

• Decreased iron stores (stage 1): Iron stores in the bone marrow and liver are reduced. Patients are asymptomatic and have normal hemoglobin levels. Serum ferritin levels and bone marrow iron levels are reduced. The main signs of iron depletion are increased iron absorption, indicating increased vulnerability or the possibility of developing iron deficiency.
• Iron-deficient erythropoiesis (stage 2): erythropoiesis activity decreases due to a lack of iron, which is necessary for inclusion in the heme portion of hemoglobin. The concentration of hemoglobin in the blood begins to decrease, the content of free protoporphyrin in erythrocytes increases. This stage is also characterized by the absence or decrease of iron stores, low concentration of iron in the blood serum, an increase in TIBC, and low transferrin saturation. Hematocrit values are practically no different from normal.
• Iron deficiency anemia (stage 3) is the advanced stage of the disease. Serum ferritin and transferrin saturation are very low. Other laboratory features of this stage include decreased iron stores, low serum iron, increased TIBC, and low hemoglobin.

Increased serum ferritin levels may be detected in the following diseases: excess iron [e.g., hemochromatosis (ferritin concentration above 500 μg/L), some liver diseases), inflammatory processes (pulmonary infections, osteomyelitis, arthritis, systemic lupus erythematosus, burns), some acute and chronic diseases with liver cell damage (alcoholic liver disease, hepatitis), breast cancer, acute myeloblastic and lymphoblastic leukemia, lymphogranulomatosis. When assessing the results of increased ferritin concentration, it should be borne in mind that it is an acute phase protein, therefore, its increase may reflect the body's response to the inflammatory process. In such cases, if hemochromatosis is suspected, it is necessary to simultaneously determine the concentration of serum iron and TIBC. If the ratio of serum iron to TIBC exceeds 50-55%, then the patient most likely has hemochromatosis, not hemosiderosis.

Ferritin determination is of greatest importance in diagnosing iron metabolism disorders. A decrease in ferritin content is detected in iron deficiency and hemolytic anemia with intravascular hemolysis. In patients with chronic kidney disease, insufficient accumulation of iron in the body can be determined when the ferritin content in the blood serum is below 100 μg/l.

The use of ferritin determination in diagnostics and monitoring of oncological diseases is based on the fact that in certain organs and tissues, in the presence of neoplasms (acute myeloblastic and lymphoblastic leukemia, lymphogranulomatosis, liver tumors), iron deposition is disrupted, and this leads to an increase in ferritin in the blood serum, as well as its increased release from cells during their death.