Detecting Levels of Iron Storage

Ferritin is the body’s major iron-storage protein and its levels in serum are parallel to iron stores. Normally, 1 ng/mL of serum ferritin is related to about 8 mg  of iron in storage. It rises somewhat in males and post-menopausal females. Any rise or decrease in levels of serum ferritin indicates available iron stores in the body. 

As a diagnostic tool, serum ferritin is the most sensitive test of iron-deficiency anemia in a patient. In presence of iron deficiency, ferritin is generally the first sign followed by decreased iron levels and changes noted in red blood cells such as size, color and number. Low levels of ferritin indicate reduced iron stores or, rarely, malnutrition due to protein depletion. A decrease can also result from hemodialysis. Levels below 10 mg/100 mL is a diagnosis of iron-deficiency anemia. 

Higher levels, in contrast, indicate hemochromatosis, hemosiderosis, iron poisoning, or a recent blood transfusion. A higher level of ferritin can also be found in patients with megaloblastic anemia, hemolytic anemia and chronic hepatitis. It is also elevated in those with chronic disease states such as chronic liver disease, uremia, alcoholism, collagen diseases or neoplasm. 

The serum ferritin study is limited because ferritin may act as an acute-phase reactant protein such as in states of inflammatory diseases, infections, metastatic cancer and lymphomas. In these cases, ferritin levels may increase one or two days after onset and peak at three to five days. To classify anemias, tests of serum ferritin should be accompanied with serum iron levels and total iron-binding capacity. 

There are also interfering factors with serum ferritin, mainly blood transfusions, recent dietary intake of red meat, hemolytic diseases, iron storage disorders like hemochromatosis, menstruation (women will have decreased ferritin levels after menstruation), and drugs that increase ferritin levels.

Summarized from

Pagana, K.D., Pagana, T.J. Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. Mosby Elsvier, 2006, pp 249-50.

Published by David Despain, MS, CFS

David is a science and health writer living on Long Island, New York. He's written for a variety of publications including Scientific American, Outside Online, the American Society for Nutrition's (ASN) Nutrition Notes Daily, and Institute of Food Technologists' (IFT) Food Technology magazine and Live! blog. He's also covered new findings reported at scientific meetings including Experimental Biology, AAAS, AOCS, CASW, Sigma Xi, IFT, and others on his personal blog "Evolving Health." David is also an active member of organizations including the National Association of Science Writers (NASW), the American Association for the Advancement of Science (AAAS), the American Society for Nutrition, the Institute of Food Technologists, and the National Audubon Society. David has a master's degree in human nutrition from the University of Bridgeport, and a bachelor's degree in English from University of Illinois at Springfield. He also earned his Certified Food Scientist credential from the Institute of Food Technologists.

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