Ferritin is a protein that stores iron inside cells. While high ferritin is often linked to iron overload, it also acts as an acute phase reactant, rising with inflammation or infection. A high ferritin result requires further investigation to find the cause.
Inflammation, Infection, and Chronic Illness
One common cause of high ferritin is inflammation. As an acute phase reactant, ferritin levels increase during inflammation or infection. This can make diagnosing iron deficiency difficult in people with inflammation, as their ferritin might look normal or high despite low iron.
Conditions that can raise ferritin include autoimmune disorders like rheumatoid arthritis, chronic kidney disease, acute infections like sepsis, some cancers, and obesity.
Liver Disease and Metabolic Factors
The liver stores most ferritin, so liver damage can release it into the blood. Chronic alcohol use is a major cause, as it can cause liver inflammation and damage, releasing ferritin. In alcohol-related liver disease, high ferritin often reflects liver injury, not just iron overload. Non-alcoholic fatty liver disease (NAFLD) is linked to metabolic syndrome, insulin resistance, and obesity, all contributing to high ferritin. Chronic hepatitis B or C can also cause liver inflammation and higher ferritin.
Iron Overload Disorders
Sometimes, high ferritin means too much iron is stored in the body, known as iron overload or hemochromatosis.
Hereditary hemochromatosis is a genetic disorder (often from HFE gene changes) causing excess iron absorption. Secondary hemochromatosis isn't genetic; it's often caused by multiple blood transfusions. People with certain anemias, like thalassemia, can also get iron overload and high ferritin. Taking too much iron from supplements can also cause iron overload and raise ferritin.
Other Contributing Factors
Other factors can increase ferritin.
Over-supplementation with iron can be a factor. Some drugs, like erythropoiesis-stimulating agents used for kidney disease or chemotherapy, can increase ferritin. Porphyria, a rare group of disorders, also causes increased blood ferritin.
Comparison of High Ferritin Causes
| Cause Category | Commonality | Underlying Mechanism | Associated Symptoms | Key Diagnostic Clue |
|---|---|---|---|---|
| Inflammation / Infection | Very Common | Ferritin acts as an acute phase reactant. | Fatigue, fever, joint pain, symptoms of specific illness. | May have normal transferrin saturation; often resolves with treatment of underlying condition. |
| Liver Disease | Common | Damaged hepatocytes leak stored ferritin. | Fatigue, upper abdominal pain, jaundice, symptoms of liver failure. | Elevated liver enzymes (ALT, GGT); history of alcohol use or obesity. |
| Hereditary Hemochromatosis | Uncommon (Genetic) | Genetic mutation causes excessive absorption of dietary iron. | Joint pain, fatigue, erectile dysfunction, bronze skin, diabetes. | High transferrin saturation (>45%) and genetic testing for HFE gene mutation. |
| Excessive Iron Intake | Uncommon | Over-supplementation or repeated transfusions bypasses normal iron absorption controls. | Varies depending on severity and duration; can mimic HH symptoms. | History of high iron supplementation or multiple blood transfusions. |
| Metabolic Syndrome | Common | Chronic, low-grade inflammation associated with obesity and insulin resistance. | Fatigue, high blood pressure, high blood sugar, increased abdominal fat. | Associated with elevated BMI, high glucose levels, high triglycerides. |
Conclusion
High ferritin is non-specific and needs further medical review. It can mean significant iron overload, but is often a sign of inflammation from conditions like liver disease, autoimmune disorders, and metabolic issues. A doctor will look at your history, other test results (like transferrin saturation), and symptoms to find the cause. High ferritin prompts a deeper look into your health. {Link: Cleveland Clinic https://my.clevelandclinic.org/health/diagnostics/17820-ferritin-test}
