1085. Ferritin

Ferritin is the main protein responsible for iron storage, reflecting its reserves in the body. Ferritin testing is one of the most sensitive methods for assessing iron metabolism and allows detection of both deficiency – even before the development of early asymptomatic changes – and overload. Unlike serum iron, the level of which fluctuates throughout the day, ferritin reflects long-term accumulation, making it a key indicator in the diagnosis of anemia, inflammatory, and chronic diseases.

At the same time, ferritin is an acute-phase protein, therefore its level may increase in the presence of inflammation regardless of the actual state of iron content.

Determination of ferritin levels in the blood is an informative indicator reflecting the volume of micronutrient reserves in the body. This allows assessment of the balance between intake, utilization, and storage, as well as timely detection of abnormalities.

What do the results mean? Reference values

Determination of ferritin levels is an informative marker that reflects total body reserves and allows assessment of their adequacy, as well as the balance between intake, absorption, and storage. This test enables the physician not only to diagnose already established disorders but also to identify early changes that are not yet accompanied by pronounced symptoms, which is important for timely correction and prevention of further complications.

Reference values of ferritin depend on the patient's sex and age and are indicated in the result report. Ferritin norms are individual; therefore, their assessment should be carried out comprehensively: considering complete blood count parameters, transferrin levels, the degree of its iron saturation, and serum iron concentration.

Why does ferritin level decrease and what does it affect?

A decreased ferritin level is one of the earliest laboratory indicators of depleted iron stores, occurring even before hemoglobin decreases. This condition is called latent (hidden) deficiency: storage is already reduced, but transport of the micronutrient is partially preserved.

Symptoms may be nonspecific: increased fatigue, reduced performance, impaired concentration, brittle nails, hair loss. That is why it is important to test ferritin even with normal hemoglobin levels.

The main causes of decrease include:

• insufficient intake of the micronutrient – unbalanced nutrition, vegetarianism without correction;
• chronic blood loss – heavy menstruation, occult gastrointestinal bleeding, regular blood donation;
• impaired absorption – celiac disease, inflammatory bowel diseases, post-surgical conditions;
• increased demand – pregnancy, lactation, intensive growth in children and adolescents.

Elevated ferritin levels: why and what does it affect

An elevated ferritin level is a clinically significant but nonspecific indicator, as it may increase in response to inflammation regardless of actual iron stores. For correct interpretation, it is advisable to assess it in combination with C-reactive protein to exclude the influence of inflammatory processes.

The main causes of increased ferritin include:

• acute and chronic inflammatory processes, autoimmune diseases, and infections;
• liver pathology – viral hepatitis, non-alcoholic fatty liver disease, toxic damage;
• oncological diseases, especially hematological malignancies and liver tumors;
• metabolic disorders – obesity, metabolic syndrome, diabetes mellitus;
• blood transfusions or treatment with iron preparations;
• hereditary hemochromatosis with excessive intestinal absorption of the micronutrient.

In cases of true overload, excess accumulates in tissues, affecting the liver, heart, and pancreas, which may lead to cirrhosis, cardiomyopathy, and diabetes mellitus. Isolated elevation of the indicator does not always indicate excess – in many cases it is a marker of inflammation or associated pathology.

What may affect the result?

Ferritin level is a dynamic indicator sensitive to a wide range of factors. When interpreting, it is important to consider clinical condition, lifestyle, and comorbidities. Inflammatory processes, infections, and liver diseases may artificially increase the indicator, masking the true state of iron reserves. Iron supplementation, frequent blood transfusions, pregnancy, and intense physical activity also affect the result. Therefore, diagnostics should be comprehensive taking into account the clinical picture and additional laboratory parameters.

Ferritin testing is recommended in the following cases:

• In the presence of anemia symptoms: fatigue, weakness, pale skin, dizziness, reduced performance.
• When latent deficiency is suspected: even with normal hemoglobin, since latent deficiency may gradually affect the cardiovascular and nervous systems, well-being, concentration, and the condition of skin and hair.
• To monitor the effectiveness of iron therapy: assessment of restoration of iron stores and adjustment of treatment.
• When overload is suspected: hemochromatosis or secondary accumulation in cases of frequent blood transfusions.
• For patients with chronic kidney, liver, and cardiovascular diseases. For women planning pregnancy and pregnant women – insufficient micronutrient stores may affect fetal health.

Ferritin testing is also recommended for donors, vegetarians, women with heavy menstruation, and athletes.

Ferritin testing is one of the important indicators in the comprehensive assessment of health status, allowing detection of both iron deficiency and excess, performing differential diagnosis of anemia, and optimizing treatment strategy.

• Venous blood

In order to exclude factors that may affect the test results, we recommend to follow the preparation rules: