Iron is an essential mineral for human life, playing an important role in metabolic processes, including DNA synthesis and oxygen transportation. The body must regulate iron levels within an optimal range, as deficiency and toxicity can both lead to serious health consequences. The evaluation of iron status is best performed by measuring ferritin, the protein that stores iron. Understanding and correctly interpreting ferritin blood test results enables healthcare professionals to diagnose iron-related disorders and tailor appropriate interventions. With the ability to shed light on the body's iron status, the ferritin blood test is a valuable tool in preventive and functional healthcare.

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What Is Ferritin?

Ferritin is a protein found in virtually all cells that serves as cellular storage for iron. It acts as a reservoir, storing iron in a controlled and soluble form, preventing iron from causing harmful reactions in the body. The majority of ferritin iron stores are found in the liver, spleen, and bone marrow. (8)

Ferritin's role in iron storage is crucial for maintaining a delicate balance of iron levels, ensuring the proper functioning of various physiological processes. When the body absorbs excess iron, ferritin captures it, storing the surplus iron safely. Conversely, when the body needs iron, ferritin releases the stored iron in a regulated manner, thus providing a continuous supply of this essential mineral for vital functions such as oxygen transportation and energy production. (13) 

Ferritin correlates strongly with total-body iron stores, and so it is a marker that is used first-line to screen for a patient's iron status, especially those at risk for iron deficiency, including people with restricted diets, heavy menstrual periods, malabsorptive disorders, or who are pregnant. (10)

Why Is Ferritin Testing Important?

Serum ferritin levels reflect total intracellular iron, total-body iron stores, and iron status. Until the development of serum ferritin assays, the only way to assess body iron stores was through an invasive bone marrow specimen collection. Now, the serum ferritin blood test allows doctors to easily screen for iron deficiency and other disorders of iron metabolism with a simple, noninvasive blood draw. (9) 

If body iron stores are low, serum ferritin concentration will be low. Conversely, high serum ferritin concentrations are associated with high iron stores (i.e., iron overload). However, high levels must be interpreted carefully because ferritin is also an acute-phase reactant. Acute-phase reactants are proteins that increase in response to chronic inflammatory conditions, including obesity, alcoholism, and infection. This protective mechanism has evolved to sequester iron within cells to limit its availability to pathogens. (9)

Ferritin levels often change before serum iron and other markers of iron metabolism. Healthcare professionals often rely on ferritin levels when assessing and diagnosing iron-deficiency anemia and other iron-related disorders because of this early responsiveness to changes in iron levels. Regular monitoring of ferritin levels helps detect iron imbalances early, allowing for prompt intervention and appropriate management of iron-related conditions.

Interpreting Ferritin Test Results

Interpreting serum ferritin lab results is essential in understanding an individual's iron status. There is a range of normal ferritin levels depending on age, sex, and individual health factors. Normal value ranges may also vary slightly among different laboratories. Levels below this range indicate iron deficiency. In such cases, individuals might experience fatigue and weakness due to insufficient iron for essential bodily functions.

On the other hand, high ferritin levels exceeding the normal range may signal iron overload. Inflammatory conditions can elevate ferritin levels even in the absence of iron overload (8). Hence, healthcare providers need to consider these factors when interpreting results. 

The table below outlines standard lab reference values for interpreting ferritin results (8): 

Ferritin is often measured alongside complementary iron tests, including serum iron, total iron-binding capacity (TIBC), and transferring saturation. Serum iron measures the actual amount of iron in the blood, TIBC assesses the body's capacity to bind and transport iron, and transferrin saturation tells us how much of our iron is bound to its transport protein in circulation. Interpreting these tests together provides a broader perspective on iron metabolism and can help provide insight into abnormal ferritin levels. For instance, low ferritin levels coupled with low serum iron and high TIBC suggest iron deficiency anemia. Conversely, high ferritin with high serum iron and low TIBC could indicate iron overload. (5) 

Causes and Implications of Low Ferritin Levels 

A low ferritin occurs when there are low iron levels in the body. Causes of iron deficiency include inadequate dietary iron intake, poor absorption of iron, or excessive blood loss (4). 

Inadequate intake of iron-rich foods, as is often the case with vegetarian or vegan diets, can lead to insufficient iron levels. Additionally, rapid growth phases, such as during childhood, adolescence, and pregnancy, increase the body's iron requirements, making individuals more susceptible to deficiency if their diet doesn't meet these demands. Certain medical conditions, such as celiac disease and Crohn's disease, can impair the body's ability to absorb iron from food, leading to deficiency even in cases of sufficient dietary intake. (12) 

Chronic blood loss causes continuous iron loss from the body. This is often due to gastrointestinal pathologies like ulcers, gastritis, or colorectal cancer that cause bleeding. Women with heavy menstrual periods or people who frequently donate blood are also at higher risk. (12)

Without sufficient iron, the body cannot produce enough hemoglobin, the iron-carrying protein component of red blood cells that allows them to carry oxygen. Iron deficiency anemia (IDA) will result. IDA commonly causes symptoms including fatigue, dizziness, shortness of breath, pale skin, and exercise intolerance. Without treatment, severe iron deficiency and IDA can cause chronic fatigue, restless legs syndrome, pregnancy complications, and even heart failure. (7) 

Causes and Implications of High Ferritin Levels

High ferritin levels can indicate iron overload, caused by excessive dietary or supplemental iron intake or an iron storage disorder, such as hemochromatosis. Iron is essential for various biological processes, but when its levels become too high, it cannot be efficiently eliminated from the body. This excess iron starts to deposit in organs and tissues, creates free radical-induced injury, and leads to significant damage over time. Tissue injury can lead to progressive heart and liver failure, arthritis, endocrine dysfunction, and early mortality. (13) 

Hereditary hemochromatosis is a genetic disorder in which excessive iron accumulation occurs in the body. Iron depositions cause damage to organs in which they accumulate. Symptoms of hemochromatosis include joint pain, hair loss, abdominal pain, fatigue, darkening of the skin, sexual dysfunction, diabetes mellitus, and organ failure. (11) 

Elevated ferritin may also occur secondary to frequent blood transfusions, obesity, alcoholism, liver disease, chronic inflammation, infection, and malignancy (8).  

Addressing Abnormal Ferritin Levels

Addressing abnormal ferritin levels requires a multifaceted approach tailored to the specific diagnosis. Regular monitoring and follow-up after the initial diagnosis are crucial to managing abnormal ferritin levels. Healthcare providers closely track ferritin levels and complementary labs to assess the effectiveness of interventions and make necessary adjustments through the treatment process. 

Natural Remedies for Low Ferritin

Dietary adjustments play a pivotal role in correcting low ferritin levels. Iron-rich foods such as red meat, poultry, fish, lentils, and fortified cereals can naturally boost iron intake. Additionally, iron supplements prescribed by healthcare professionals may be necessary to replenish iron stores efficiently. These supplements are typically taken with vitamin C, which enhances iron absorption. (2)

Optimization of iron levels through diet and supplementation must be done in conjunction with identifying and correcting the underlying cause of iron deficiency. Correcting the underlying cause of iron deficiency can prevent future deficiency recurrence. (7) 

Treatments for High Ferritin

Therapeutic phlebotomy, a procedure akin to blood donation, is the standard treatment for reducing excess iron. During this process, a specific amount of blood containing excess iron is removed, lowering overall iron levels in the body. In cases where conditions like hemochromatosis cause iron overload, chelation therapy may be employed. Chelation agents bind to excess iron and facilitate its excretion from the body, helping to normalize ferritin levels. (14) 

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Summary

In conclusion, empowering health through ferritin understanding is paramount for individuals striving to maintain optimal well-being. Ferritin is a crucial indicator of iron status, influencing overall health status. By taking a proactive role in monitoring their ferritin levels and consulting health professionals, individuals can effectively manage iron-related conditions, whether it involves adopting dietary changes, taking supplements, or undergoing medical treatments. This knowledge empowers individuals to make informed decisions about their health, ensuring early detection of imbalances and timely interventions to achieve iron levels within an optimal range.