Evaluation and Management of Extreme Hyperferritinemia

Introduction to Hyperferritinemia

• Ferritin is an acute phase reactant that increases during inflammation, making it less reliable as a sole indicator of iron status in chronic disease states 1
• In inflammatory conditions, ferritin levels can be markedly elevated despite normal or low iron stores 1
• Serum ferritin levels between 100-700 ng/mL in the presence of inflammation can indicate functional iron deficiency or inflammatory iron block 1

Iron Overload and Its Consequences

• Liver cell damage has been noted in patients with transfusional hemosiderosis who had serum ferritin levels exceeding 7,500 ng/mL and transferrin saturation greater than 88% 2, 3
• Iron deposition in proximal muscle has been demonstrated in iron-overloaded hemodialysis patients with ferritin levels between 1,030 to 5,000 ng/mL, particularly in those who inherited hemochromatosis alleles 2, 3

Considerations in Chronic Kidney Disease

• When evaluating ferritin levels in patients with chronic kidney disease, consider that inflammatory states may mask underlying iron deficiency despite elevated ferritin values 1