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Ferritin

Also known as: Serum ferritin level
Formal name: Ferritin, serum
Related tests: CBC, Serum iron, TIBC & UIBC, Transferrin, Iron tests, Zinc Protoporphyrin (ZPP)

The Test

How is it used?

The ferritin test is ordered to assess a person's iron stores in the body. The test is sometimes ordered along with an iron test and a TIBC to detect the presence and evaluate the severity of an iron deficiency or overload.

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When is it ordered?

The ferritin test may be ordered, along with other iron tests, when a routine CBC shows that a person's hemoglobin and hematocrit are low and their red blood cells are smaller and paler than normal (microcytic and hypochromic), suggesting iron deficiency anemia even though other clinical symptoms have not yet developed.

Early iron deficiency usually causes no physical effects at all. If a person is otherwise healthy, symptoms seldom appear before the hemoglobin in the blood drops below a certain level (10 g per deciliter). However, as the iron-deficiency progresses, symptoms may begin to develop and a doctor may order ferritin as wells as other iron-related tests. The most common symptoms of iron deficiency anemia include:

  • Chronic fatigue/tiredness
  • Weakness
  • Dizziness
  • Headaches

As iron stores continue to be depleted, there may be shortness of breath, ringing in the ears (tinnitus), drowsiness, and irritability. If the anemia progresses in severity, chest pain, headaches, leg pains, shock, and even heart failure may occur. Children may develop learning (cognitive) disabilities. Besides the general symptoms of anemia, there are certain symptoms that are characteristic of iron deficiency. These include pica (cravings for specific substances, such as licorice, chalk, dirt, or clay), a burning sensation in the tongue or a smooth tongue, sores at the corners of the mouth, and spoon-shaped finger- and toe-nails.

A ferritin level may also be ordered when iron overload is suspected. Symptoms of iron overload will vary from person to person and tend to worsen over time. They are due to iron accumulation in the blood and tissues. Symptoms may include:

  • Joint pain
  • Fatigue, weakness
  • Lack of energy
  • Abdominal pain
  • Loss of sex drive
  • Heart problems

To confirm the presence of iron overload, other iron tests (iron, TIBC) and a genetic test for hereditary hemochromatosis may be ordered as well.

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What does the test result mean?

Looking for reference ranges?

Ferritin levels are often evaluated in conjunction with other iron tests. A summary of the changes in iron tests seen in various diseases of iron status is shown in the table below.

 

Disease Iron TIBC/Transferrin UIBC

%Transferrin

Saturation

 Ferritin
Iron Deficiency Low High High Low Low
Hemochromatosis High Low Low High High
Chronic Illness Low Low Low/Normal Low Normal/High
Hemolytic Anemia High Normal/Low Low/Normal High High
Sideroblastic Anemia Normal/High Normal/Low Low/Normal High High
Iron Poisoning High Normal Low High Normal

Ferritin levels are low in people who have iron deficiency and are elevated in those with hemochromatosis and other excess iron storage disorders and in those who have had multiple blood transfusions.

Ferritin is an acute phase reactant and thus may be increased in people with inflammation, liver disease, chronic infection, autoimmune disorders, and some types of cancer. Ferritin is not typically used to detect or monitor these conditions.

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Is there anything else I should know?

Normally, most ferritin is found inside of cells with only a small amount in the blood. When there is damage to organs that contain ferritin, such as the liver, spleen, and bone marrow, ferritin levels can become elevated even though the total amount of iron in the body is normal.

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