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Clinical Use

  • Diagnose iron deficiency (anemia) or excess (hemochromatosis, sideroblastic anemia)

  • Monitor iron therapy (supplemental iron or removal of excess iron)

Clinical Background

In the body, iron is incorporated into heme proteins (including hemoglobin), transported via transferrin, or stored in ferritin and hemosiderin. Serum ferritin reflects the total amount of stored iron, being directly proportional to that stored in the tissues and the circulation. Levels decrease very early during the development of iron deficiency anemia; hence, ferritin is useful for early detection of iron deficiency. The diagnosis may be confirmed with a bone marrow stain. Measurement of serum ferritin is also valuable in differentiating between anemia caused by low iron stores (iron-deficiency anemia) and anemia caused by inadequate iron utilization. Furthermore, ferritin is utilized in diagnosis of iron overload disorders including sideroblastic anemia and hemochromatosis. Although transferrin saturation (calculated from serum iron and total iron binding capacity [TIBC]) is more sensitive for early detection of hemochromatosis, ferritin confirms the diagnosis and indicates the need for a liver biopsy. Finally, ferritin levels may be used to monitor therapeutic response in iron deficiency anemia and iron overload.



Interpretive Information

Reference ranges vary with age, sex, and methodology.

Decreased ferritin levels are associated with iron deficiency anemia. Elevated levels, on the other hand, are associated with sideroblastic anemia, hemochromatosis, and acute iron poisoning. Ferritin may also be increased in acute and chronic liver disease (including hepatitis and hepatoma), in non-iron deficiency anemia (aplastic, megaloblastic, hemolytic, thalassemia major and minor, spherocytosis, porphyria cutanea tarda), alcoholism, pregnancy, malignancy (leukemia, lymphoma, Hodgkin’s disease, renal cell carcinoma), infection, inflammation (arthritis), hyperthyroidism, Gaucher’s disease, acute myocardial infarction, and following a recent blood transfusion. In acute phase reactions, a bone marrow stain may be required to detect concurrent iron deficiency anemia.


Content reviewed 12/2011

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