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Raised Ferritin Level
Introduction:
- It is increase in serum ferritin level >300 microgram/L in men and >200 microgram/L in women
Causes
- Increased synthesis due to iron accumulation
- Hereditary hemochromatosis
- Hereditary aceruloplasminemia
- Iron overload due to recurrent blood transfusion or excess iron administration
- Ineffective erythropoiesis- Sideroblasticanemia, refractory anemia with ringed sideroblasts etc
- Thalassemia
- Atransferrinemia
- Ferroportin disease
- Porphyria cutaneatarda
- Benign hyperferritinemia due to FTL gene mutation
- Increased synthesis without iron accumulation
- Malignancies
- Malignant or reactive histiocytosis (HLH)
- Hereditary hyperferritinemia with or without cataract
- Goucher disease
- Acute and chronic infections
- Chronic inflammatory disorders- SLE, rheumatoid arthritis, Still’s disease etc
- Metabolic syndrome- Associated with hyperglycemia, dyslipidemia, obesity and hypertension
- Chronic kidney disease
- Autoimmune diseases
- Increased ferritin due to cellular damage
- Liver disease including- liver necrosis, chronic viral hepatitis, alcoholic liver disease, non-alcoholic steatohepatitis
Investigations
- Hemogram
- S. Iron, TIBC, Transferrin saturation
- Ophthalmology referral for cataract
- RFT
- LFT
- Inflammatory markers- CRP, ESR
- Glycosylated haemoglobin
- Lipid profile
- USG abdomen
- Fibroscan (transient elastography)
Diagnostic algorithm:
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