Ferritin is an iron storage protein that can be used to clearly distinguish iron deficiency anemia from tumor or infectious anemia. It belongs to the acute phase proteins (see below). Ferritin is found primarily in the spleen, liver, and bone marrow, as well as the reticuloendothelial system.
The procedure
Material needed
- Blood serum
- Or plasma
Preparation of the patient
- Not necessary
Disruptive factors
- Not known
Normal value – women
| Age | Normal value in μg/l |
| ≥ 16 yr. | 15-150 |
| 65-90- yr. | 15-650 |
Normal value – men
| Age | Normal value in μg/l |
| ≥ 16 yr. | 30-400 |
| 65-90- yr. | 15-665 |
Normal value – children
| Age | Normal value in μg/l |
| Cord blood | 30-276 |
| – 30 days | 150-450 |
| 31-90 days | 80-500 |
| 91 days to <16 yrs. | 20-200 |
1 µg/l = 1 ng/ml
Indications
- Suspected iron deficiency anemia
Interpretation
Interpretation of elevated values (hyperferritinemia).
- Hemochromatosis (iron storage disease), primary (congenital);secondary: frequent blood transfusions; hemoglobinopathy – disorders caused by disturbances in the formation of hemoglobin (red blood pigment).
- Iron utilization disorders:
- Folic acid deficiency
- Vitamin B12 deficiency
- Hemoglobinopathies – diseases caused by disorders of hemoglobin, the red blood pigment in red blood cells.
- Porphyria – metabolic disorder that can be congenital or acquired; leads to deposition of metabolic products in the various organs.
- Thalassemia – genetic disease that leads to changes in hemoglobin (blood pigment).
- Lead intoxication
- Iron distribution disorders (blockade of iron release from stores).
- Chronic inflammation, unspecified (e.g., enteritis, hepatitis, etc.) (acute-phase protein).
- Hemolytic anemia – anemia caused by the destruction of erythrocytes (red blood cells).
- Neoplasms (neoplasms), unspecified (due toFerritin is an acute phase protein) [ferritin ↑; serum iron ↓↓; transferrin ↓]Note: In chronic iron deficiency anemia, i.e., hypochromic, microcytic anemia with a decreased ferritin level, this may be increased in tumor disease!
Interpretation of lowered values (hypoferritinemia).
- Iron deficiency
- Iron loss due to bleeding
- Transferrin Deficiency:
- Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles): Proteinuria (excretion of protein in urine) with protein loss greater than 1 g/m²/body surface area per day; Hypoproteinemia, peripheral edema due to hypalbuminemia of < 2.5 g/dl in serum; Hyperlipoproteinemia (lipid metabolism disorder).
- Exudative enteropathy (protein loss enteropathy) – gastrointestinal disease in which there are large protein losses.
- Burns
- Iron resorption disorder
- Z. E.g. celiac disease (gluten-induced enteropathy) – chronic disease of the mucosa of the small intestine (small intestinal mucosa), which is based on hypersensitivity to the cereal protein gluten.
- Increased iron requirements:
- Growth phase
- Pregnancy/breastfeeding period
Notice.
- Ferritin is an acute-phase protein, which means it increases in inflammation or tumors. In this context, low ferritin levels may be “masked” by inflammatory responses. Therefore, assessment of ferritin should be performed in parallel with C-reactive protein (acute-phase protein), if necessary:
- CRP <5.0 mg/:
- Females: Ferritin < 10 ng/ml
- Men: ferritin < 20 ng/ml
- CRP > 5 mg/l:
- Women: Ferritin < 20 ng/ml
- Men: ferritin < 100 ng/ml
- CRP <5.0 mg/:
- Ferritin and transferrin concentration always behave in opposite ways.
- A ferritin concentration of < 15 µg/l is considered probative of manifest iron deficiency.
- Increased ferritin levels in older age are associated with “inflammaging” (inflammaging).
- Ferritin concentrations of > 300 µg/l should be excluded as causes of primary or secondary hemochromatosis.