Ferritin Blood Test

Ferritin tests help diagnose iron deficiency or iron overload.

Ferritin is the major iron storage protein of the body. Ferritin levels can be used to indirectly measure how much iron is in the body. Ferritin has the shape of a hollow sphere that permits the entry of a variable amount of iron for storage (as ferric hydroxide phosphate complexes).

Ferritin is required for the regulation of free iron levels in circulation and within cells. It is present in most cells of the body, primarily in the liver, spleen, marrow, duodenum, skeletal muscle, and others. The primary function of ferritin is to store iron and release it in a controlled way. This is crucial because free iron is potentially harmful, as it can produce free radicals.

Ferritin promotes iron homeostasis (balance) in the body. The amount of ferritin produced by the body is directly proportional to the amount of iron that is accessible, and higher iron levels lead to increased ferritin production. Because ferritin levels represent bodily iron storage, they are often assessed in blood tests to determine the iron levels in the body. Ferritin levels can be high or low, indicating iron overload or deficiency.

Ferritin is not the same as iron. Ferritin is a protein complex that stores and releases iron to maintain the body's iron levels. Iron, on the other hand, is a mineral essential for a variety of bodily functions, including the production of hemoglobin — the molecule in red blood cells that transports oxygen in the blood. Iron also plays a crucial role in other important physiological processes, such as energy production and DNA synthesis. Ferritin stores iron in a nontoxic form and releases it as needed, maintaining a steady supply of iron for metabolic demands.

A ferritin level test is crucial for assessing the level of iron stored in your body.

Low ferritin levels

Low ferritin levels often indicate iron deficiency, which can result from:

• Inadequate dietary intake.
• Chronic blood loss (such as from heavy menstrual periods or gastrointestinal conditions).
• Poor iron absorption (due to diseases such as celiac or Crohn's).
• Increased iron demands during pregnancy or adolescence.
• Chronic diseases, such as kidney disease, may mask actual iron levels despite low ferritin.

Normal ferritin levels suggest sufficient iron stores for healthy function.

High ferritin levels

High ferritin levels could be a sign of iron overload, especially in conditions such as hemochromatosis.

A few factors that may lead to high ferritin levels include:

• Inflammation
• Infection
• Liver diseases (such as hepatitis or fatty liver)
• Chronic inflammatory conditions such as rheumatoid arthritis
• Certain cancers such as leukemia and lymphoma

Ferritin levels not only assess iron status but also help diagnose and monitor various medical conditions. It is often part of a broader diagnostic process, as ferritin can be influenced by many factors.

The ferritin test uses venous blood withdrawn during any routine blood test. No special preparation for the test is necessary. Fasting is not necessary.

To prepare for a ferritin blood test, it's important to note the following:

• Fasting: Usually, fasting is not necessary for a ferritin test, but follow any specific instructions given by your health care provider or the lab. Sometimes, you may be advised to avoid eating or drinking anything except water for a few hours before the test, especially if other blood tests are being done simultaneously that require fasting.
• Medications: Inform your doctor about any medications, supplements, or herbal treatments you are taking, as some of these can affect ferritin levels. Your doctor might ask you to stop taking certain medications before the test but do not do so without medical advice.
• Time of day: The timing of the blood test can sometimes influence the results, so it is often recommended to have blood drawn in the morning.
• Physical activity: Avoid strenuous physical activity immediately before the test, as it might affect the results.
• Alcohol and smoking: It is advisable to avoid alcohol and smoking before the test, as these can also influence ferritin levels.
• Health concerns: If you have any ongoing health issues, particularly those related to inflammation or liver function, discuss these with your healthcare provider, as they might impact your ferritin levels.

Following these simple steps can help ensure your ferritin blood test results are accurate and reflective of your true iron storage levels.

The ferritin test involves a simple blood draw, usually from a vein in the arm, after placing a tourniquet to make the veins more visible.

A needle attached to a vacuum collection device is inserted into a vein, often a vein in the antecubital fossa (crease of the elbow), after the area has been cleaned. Venous blood can also be taken from other sites.

After the needle is removed, a bandage is applied to the site. The collected blood is then sent to a laboratory for analysis to measure ferritin levels with specific antibodies. Results are typically available within a few days and are interpreted by your doctor considering your health and other tests. The test is quick and generally safe, with minimal risks such as slight bruising or discomfort at the injection site.

The results may vary slightly among laboratories, but in general, normal ferritin levels range from 12 to 300 nanograms per milliliter of blood (ng/mL) for males and 12 to 150 ng/mL for females.

Normal ferritin test results vary depending on age and sex. Women tend to have lower ferritin levels than men due to regular iron loss from menstruation.

It is important to note that normal ranges can differ for children and adolescents, and they are often lower than those for adults. Newborns generally have much higher ferritin levels, which gradually decrease as the child ages.

High or low ferritin levels can indicate various health conditions, such as:

• Low ferritin levels often suggest iron deficiency, which could lead to iron deficiency anemia.
• High ferritin levels might indicate iron overload, inflammation, liver disease, or other medical conditions.

Your healthcare provider will interpret your ferritin test results in the context of your overall health, symptoms, and other diagnostic tests. If your ferritin levels are outside the normal range, further evaluation and tests might be necessary to determine the underlying cause.

Ferritin levels can vary widely by age and sex. As people age, there tends to be a slight increase in ferritin levels.

Here are typical reference ranges for ferritin levels across different age groups:

These values can vary based on the methods used by different labs.

It is important to consult with a healthcare provider who can consider individual health status, symptoms, and other factors alongside laboratory results.

Higher-than-normal levels of ferritin can be indicative of an iron storage disorder such as hemochromatosis.

Hereditary hemochromatosis is an inherited (genetic) disorder in which there is excessive accumulation of iron in the body (iron overload). In individuals with hereditary hemochromatosis, the daily absorption of iron from the intestines is greater than the amount needed to replace losses. Since the normal body cannot increase iron excretion, the absorbed iron accumulates in the body.

• A man with hemochromatosis can accumulate 20 grams of total body iron by age 40 to 50 (the normal iron content for the body is 3 to 4 grams). The excess iron deposits in the joints, liver, testicles, and heart, cause damage to these organs and cause signs and symptoms of hemochromatosis.
• Women with hemochromatosis accumulate iron at a slower rate than men because they lose more iron than men due to iron loss from menstruation. Therefore, they typically develop signs and symptoms of organ damage due to excess iron 10 years later than men.

People with hereditary hemochromatosis may have no symptoms or signs (and have normal longevity), or they can have severe symptoms and signs of iron overload that include:

• Sexual dysfunction
• Heart failure
• Joint pains
• Loss of body hair
• Stomach or abdominal pain
• Liver cirrhosis
• Diabetes mellitus
• Weight loss
• Fatigue
• Darkening of the skin

The symptoms arise because iron accumulates in the organs and leads to destruction and loss of normal function.

Other causes of a high ferritin level are chronic inflammatory medical conditions such as liver disease, rheumatoid arthritis, or some types of cancer.

Very high ferritin levels can indicate several possible health issues, and they often necessitate further investigation to determine the underlying cause.

Some of the conditions that might be associated with elevated ferritin levels:

• Iron overload: If ferritin levels are high, it could mean there's too much iron in the body. This might happen in conditions such as hemochromatosis, which is a rare genetic condition where the body stores too much iron from the diet.
• Inflammation or infection: High serum ferritin is often associated with inflammation, infection, or injury because it is an acute-phase reactant, which means its levels may increase in response to inflammation in the body. Ferritin is part of the body's natural response to fight off these issues.
• Liver disease: Liver problems, such as hepatitis, alcohol-related liver damage, or fatty liver disease, can cause high ferritin levels as the liver becomes inflamed and damaged.
• Chronic disease: Chronic inflammatory diseases such as rheumatoid arthritis and inflammation-associated severe kidney dysfunction may also increase ferritin levels.
• Certain cancers: High levels of ferritin may be associated with cancers, particularly leukemia and lymphoma, which affect the blood and lymph nodes. High ferritin may also be the marker of progression or recurrence of some cancers.
• Metabolic syndrome and obesity: High ferritin levels can be associated with metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.

What happens when ferritin is low? Lower-than-normal serum ferritin levels are seen in iron deficiency. Without enough iron, the body cannot produce sufficient levels of hemoglobin, a component of red blood cells that allows them to carry oxygen. Iron deficiency anemia is the result. Mild anemia may not produce low ferritin symptoms at all.

More serious cases of iron deficiency anemia can produce symptoms such as:

• Shortness of breath
• Fatigue
• Dizziness
• Feeling lightheaded
• Pale skin
• Fast heartbeat

Without treatment, low levels of iron can cause heart failure with symptoms including chest pain, leg pain, or ringing in the ears (tinnitus ).

Low ferritin levels can have several implications:

• Iron deficiency: Low levels of ferritin usually mean you do not have enough iron stored in your body. This can lead to iron deficiency anemia, making you tired, weak, and pale.
• Chronic blood loss: Chronic bleeding (such as heavy menstrual periods), peptic ulcer disease, hiatal hernia, colorectal cancer, or the use of certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to iron loss, which shows up as low ferritin levels.
• Poor iron absorption: Conditions such as celiac disease, Crohn's disease, or surgical removal of part of the stomach or small intestine may reduce the absorption of iron from food and lead to low ferritin levels.
• Increased iron requirements: Certain life stages, such as pregnancy or rapid growth as seen in adolescence, require more iron. If you do not get enough iron from your diet at these times, your iron stores may decline.
• Chronic diseases: Although chronic diseases often increase ferritin levels due to acute-phase response (which is a part of the body's immune response), there are instances such as chronic kidney disease, in which ferritin levels might remain low and not accurately reflect the actual iron levels because of the disease's impact on the body's iron metabolism.

To improve ferritin levels, focus on consuming a diet rich in both heme iron from animal sources such as red meat, poultry, and fish, and non-heme iron from plant sources such as lentils, beans, and leafy greens. Supplementing with vitamin C-rich foods can help increase iron absorption. Using cast iron cookware and avoiding substances that inhibit iron absorption such as phytates, polyphenols, and calcium can also be beneficial.

• Ferritin supplements: If dietary measures are insufficient, iron supplements can help. These supplements are available in a variety of forms, including pills, capsules, and liquids. These should be used under the supervision of a healthcare practitioner to avoid iron overload, which can be dangerous. It is important to choose a well-tolerated supplement and take it with vitamin C to increase iron absorption.
• Iron infusions: These are typically recommended when oral iron supplements prove ineffective or are poorly tolerated due to gastrointestinal side effects. They are also considered when there is a need for a rapid increase in iron levels. This treatment involves administering supplemental iron directly into the bloodstream via intravenous (IV) infusion. Iron infusions are commonly prescribed for individuals with iron deficiency anemia.

It is crucial to address any underlying problems that interfere with iron absorption. Regular blood tests to check ferritin levels can aid in the effective adjustment of dietary intake and treatment strategies.

Treatments aimed at reducing high ferritin levels usually focus on the underlying causes of iron overload. Phlebotomy, or therapeutic blood removal, is a regularly used method for effectively reducing iron levels, particularly in conditions such as hemochromatosis. If you are unable to undergo phlebotomy, iron chelation therapy is done, which uses medicines that bind to excess iron.

Some dietary changes may help, such as reducing the intake of iron-rich foods and vitamin C with meals, which may help reduce iron absorption. Managing conditions associated with high ferritin levels, such as liver disease or chronic inflammation, requires appropriate medical therapy and lifestyle adjustments. Regular monitoring of ferritin levels through blood tests is essential to adjust treatments and ensure effectiveness.

The ferritin blood test is a routine blood test and typically does not cause side effects. Mild bruising at the venipuncture site can occur infrequently.

You may also feel temporary soreness or discomfort at the injection site; any minor bleeding can be controlled with pressure and a bandage. You may also experience lightheadedness during or after the exam, which normally resolves with rest. The risk of infection at the puncture site is extremely low. However, a hematoma or nerve irritation may occur very rarely, manifesting as a sore raised area or temporary tingling sensation. These side effects are usually mild and temporary. If you have significant or prolonged symptoms, contact a healthcare professional.