Ferritin

Order Info
Clinical and Interpretive
Additional Info
Reference Ranges

Order Code

2090

Preferred Specimen

A 2 mL serum sample is required. Allow the SST tube to clot in an upright position for a minimum of 30 minutes, then centrifuge the sample within 2 hours of collection. Refrigerate the serum.
Note: Avoid collecting samples from patients receiving high-dose biotin therapy (>5 mg/day) until at least 8 hours after their last biotin dose.

ContainerType

Serum separator tube

Alternate Specimen Requirements

A 2 mL serum sample from a plain red top tube is acceptable. Let the sample clot in an upright position for at least 60 minutes, then centrifuge the sample and transfer the serum to a plastic transport tube within 2 hours of collection. Ensure the tube is clearly labeled as serum from a plain red top tube. Refrigerate the serum.
Note: As with the preferred specimen, avoid collecting samples from patients receiving high-dose biotin therapy (>5 mg/day) until at least 8 hours after the last biotin dose.

Minimum Volume

Adult: 0.5 mL serum
Pediatric: 0.2 mL serum (does not allow for repeat or
additional testing).

Transport Temperature

Refrigerated

Expected Turnaround Time

2 days

Specimen Stability

2 days room temperature; 1 week refrigerated; 1 year frozen

Methodology

Roche COBAS Electrochemiluminescent Immunoassay (ECLIA) this method has been standardized against the elecsys ferritin assay. The elecsys ferritin assay has been standardized against the enzymum-test ferritin method. This in turn has been standardized against the 1st international standard NIBSC “reagent for ferritin (human liver)” 80/602.

Overview

Ferritin is an intracellular protein that plays a crucial role in the storage, absorption, and release of iron in the body. It is predominantly found in the liver, bone marrow, and spleen, and the serum ferritin level typically reflects the total iron stored in the body’s tissues and circulation. Serum ferritin is considered the most reliable test for diagnosing iron deficiency. It is also used to monitor treatment in patients with hemochromatosis and to differentiate between iron deficiency anemia and other anemia types. Additionally, ferritin is an acute-phase reactant and may be elevated in various inflammatory conditions and infections.

Clinical Significance

Detection of iron deficiency (iron-deficient anemia)
- Blood loss
- Inadequate iron intake
- Increased iron utilization
- Malabsorption (celiac disease, gastric bypass)
Detection of iron overload
- Hemochromatosis
- Sideroblastic anemia
- Excess iron-storage disorder
- Multiple transfusions
Monitor therapeutic response in iron deficiency and iron overload
Useful in the differential diagnosis of hypochromic, microcytic anemias
Useful in distinguishing iron-deficient anemia from anemia of chronic disease

Additional Information

Aside from a bone marrow biopsy, serum ferritin is the most dependable marker of total body iron reserves. When combined with serum iron and transferrin saturation, it helps differentiate various types of microcytic hypochromic anemia, such as:

Iron deficiency anemia: Low ferritin, low iron, low saturation, high TIBC, high transferrin
Anemia of chronic disease: Normal or high ferritin, low iron, normal to low transferrin or TIBC
Thalassemia: Normal or high ferritin

High ferritin levels may indicate inflammation, liver disease, alcoholism, megaloblastic anemia, hemolytic anemia, sideroblastic anemia, thalassemia, or iron overload conditions such as hemochromatosis and hemosiderosis. Other conditions associated with elevated ferritin include Gaucher disease, hereditary hyperferritinemia cataract syndrome, and various cancers, including leukemia and malignant lymphoma. Extremely high ferritin levels are typically seen in iron overload, though they can also occur in conditions such as hemophagocytosis or disseminated histoplasmosis, particularly in patients with AIDS (Kirn, 1995). Both oral and intravenous iron supplementation can also lead to increased ferritin levels.

Hereditary hemochromatosis is an autosomal recessive genetic disorder caused by mutations in the HFE gene, which regulates iron metabolism. This condition results in excessive iron accumulation in the heart, liver, and pancreas, potentially leading to severe complications such as cirrhosis, liver cancer, diabetes, and heart failure. Homozygous individuals exhibit the full clinical expression of hemochromatosis. In this condition, both ferritin and iron saturation levels are elevated, with ferritin often exceeding 1000 ng/mL (SI: >2247 pmol/L). However, a normal ferritin level does not rule out homozygous hemochromatosis. Genetic testing for mutations in the HFE gene (C282Y and H63D) is available and can help confirm the diagnosis. See HFE Gene, Whole Blood.

Interpretative Information

Serum ferritin is decreased in iron deficiency anemia and increased in iron overload.

Limitations

Values obtained with different assay methods should not be used interchangeably in serial testing.
In the presence of liver disease, inflammation (such as rheumatoid arthritis), malignancy, or with iron therapy, serum ferritin may be elevated and thus not reflect iron deficiency.

References

Beutler E, Felitti V, Gelbart T, et al, “The Effects of HFE Genotypes on Measurements of Iron Overload in Patients Attending a Health Appraisal Clinic,” Ann Intern Med, 2000, 133(5):329-37.10979877

Cook JD, “Iron-Deficiency Anemia,” Baillieres Clin Haematol, 1994, 7(4):787-804.7881154

Cook JD, Flowers CH, Skikne BS. The quantitative assessment of body iron. Blood. 2003;101(9):3359–3364.12521995

Felitti VJ and Beutler E, “New Developments in Hereditary Hemochromatosis,” Am J Med Sci, 1999, 318(4):257-68.10522553

Gambino R, “Serum Ferritin Levels Are Elevated in Hyperthyroidism,” Lab Rep, 1994, 16(10):81

Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: an overview. J Gen Intern Med. 1992;7(2):145–153.487761

Holyoake TL, Stott DJ, McKay PJ, et al, “Use of Plasma Ferritin Concentration to Diagnose Iron Deficiency in Elderly Patients,” J Clin Pathol, 1993, 46(9):857-60.8227438

Kirn DH, Fredericks D, McCutchan JA, et al, “Marked Elevation of the Serum Ferritin Is Highly Specific for Disseminated Histoplasmosis in AIDs,” AIDS, 1995, 9(10):1204-5.8519465

Koduri PR, Carandang G, DeMarais P, et al, “Hyperferritinemia in Reactive Hemophagocytic Syndrome Report of Four Adult Cases,” Am J Hematol, 1995, 49(3):247-9.7604819

Kröger A, Bachli EB, Mumford A, Gubler C. Hyperferritinemia without iron overload in patients with bilateral cataracts: a case series. J Med Case Rep. 2011;5:471.21936912

Looker AC, Dallman PR, Carroll MD, et al, “Prevalence of Iron Deficiency in the United States,” JAMA, 1997, 277(12):973-6.9091669

Mavromatidis K, Fytil C, Kynigopoulou P, et al, “Serum Ferritin Levels Are Increased in Patients With Acute Renal Failure,” Clin Nephrol, 1998, 49(5):296-8.9617492

Oski FA, “Iron Deficiency in Infancy and Childhood,” N Engl J Med, 1993, 329(3):190-3.8515791

Phatak PD, Bonkovsky HL, and Kowdley KV, “Hereditary Hemochromatosis: Time for Targeted Screening,” Ann Intern Med, 2008, 149(4):270-2.18711158

Powell LW, George DK, McDonnell SM, et al, “Diagnosis of Hemochromatosis,” Ann Intern Med, 1998, 129(11):925-31.9867744

Schrier SL. Causes and diagnosis of iron deficiency anemia in the adult. UpToDate®, Basow DS, ed, Waltham, MA: UpToDate®, 2013. Available at http://www.uptodate.comAccessed January 23, 2014.

Sheehan RG, Newton MJ, and Frenkel EP, “Evaluation of a Packaged Kit Assay of Serum Ferritin and Application to Clinical Diagnosis of Selected Anemias,” Am J Clin Pathol, 1978, 70(1):79-84.

Wheby MS. Effect of iron therapy on serum ferritin levels in iron-deficiency anemia. Blood. 1980;56(1):138-140.7388178

Whitlock EP, Garlitz BA, Harris EL, et al, “Screening for Hereditary Hemochromatosis: A Systematic Review for the U.S. Preventative Services Task Force,” Ann Intern Med, 2006, 143(3):209-23.16880463

Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol. 2006;1 (Suppl 1):S4–S8.17699374

Worwood M, “The Measurement of Ferritin,” Advanced Laboratory Methods in Haematology, Chapter 11, Rowan RM, van Assendelft OW, and Preston FE, eds, London, UK: Arnold, 2002, 254.

Wu A, ed. Tietz Clinical Guide to Laboratory Tests, 4th ed, St. Louis, MO: WB Saunders/Elsevier; 2006

Diagnostic Role

Serum ferritin decrease is the earliest indicator of iron deficiency if inflammation is absent. It is usually a more sensitive test than the serum iron or TIBC for iron deficiency and for iron overload. When all these tests are used together, as is often necessary, they usually can distinguish between iron deficiency anemia and the anemia of chronic disease.

Test Setup Days

Monday through Friday PM shift

CPT

82728 Limited Coverage Test For Medicare.
Advance Beneficiary Notice Of Non-Coverage (ABN) Required
If Diagnosis Is Not Covered.
LOINC: 20567-4

Reference Range

FEMALE AGE 0-1 MONTH: 25-200 NG/ML
2-5 MONTHS: 50-200 NG/ML
6 MONTHS-15 YEARS: 7-140 NG/ML
16 YEARS AND OLDER: 13-200 NG/ML
MALE AGE 0-1 MONTH: 25-200 NG/ML
2-5 MONTHS: 50-200 NG/ML
6 MONTHS-15 YEARS: 7-140 NG/ML
16 YEARS AND OLDER: 30-400 NG/ML

UNIT CODE	UNIT CODE NAME	ANALYTE	GENDER	AGE	REFERENCE RANGE	Units of Measure
2090	FERRITIN	FERR	NOT SPECIFIED	0Y	13-400	NG/ML
2090	FERRITIN	FERR	NOT SPECIFIED	2M	25-200	NG/ML
2090	FERRITIN	FERR	NOT SPECIFIED	5M	50-200	NG/ML
2090	FERRITIN	FERR	NOT SPECIFIED	15Y	7-140	NG/ML
2090	FERRITIN	FERR	NOT SPECIFIED	150Y	13-400	NG/ML
2090	FERRITIN	FERR	MALE	0Y	30-400	NG/ML
2090	FERRITIN	FERR	MALE	2M	25-200	NG/ML
2090	FERRITIN	FERR	MALE	5M	50-200	NG/ML
2090	FERRITIN	FERR	MALE	15Y	7-140	NG/ML
2090	FERRITIN	FERR	MALE	150Y	30-400	NG/ML
2090	FERRITIN	FERR	FEMALE	0Y	13-200	NG/ML
2090	FERRITIN	FERR	FEMALE	2M	25-200	NG/ML
2090	FERRITIN	FERR	FEMALE	5M	50-200	NG/ML
2090	FERRITIN	FERR	FEMALE	15Y	7-140	NG/ML
2090	FERRITIN	FERR	FEMALE	150Y	13-200	NG/ML