Ferritin

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Also known as: Serum ferritin level

Formal name: Ferritin, serum

At a Glance

Why Get Tested?

To determine your body's total iron storage capacity

When to Get Tested?

When your doctor suspects that you may have too little or too much iron in your system

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

You may be instructed to fast for 12 hours before the test; in this case, only water is permitted.

The Test Sample

What is being tested?

This test measures the amount of ferritin in the blood. Ferritin is an iron-containing protein that is the primary form of iron stored inside of cells. The small quantity of ferritin that is released into the blood is a reflection of the amount of total iron stored in the body.

In healthy people, about 70% of the iron absorbed by the body is incorporated into the hemoglobin of red blood cells. Most of the remaining 30% is stored as ferritin or as hemosiderin, a complex of iron, proteins, and other materials. Ferritin and hemosiderin are present primarily in the liver but also in the bone marrow, spleen, and skeletal muscles.

When available iron is insufficient to meet the body's needs, iron stores are depleted and ferritin levels decrease. This may occur because of insufficient iron intake, inadequate absorption, increased need for iron - such as may occur during pregnancy, or due to a condition that causes chronic blood loss. Significant depletion of iron stores may occur before any signs of iron deficiency develop.

Iron storage and ferritin levels increase when more iron is absorbed than the body needs. Chronic absorption of excess iron will lead to the progressive buildup of iron compounds in tissues and organs and may eventually cause their dysfunction and failure. This happens in hemochromatosis, a genetic disease in which the body absorbs too much iron, even on a normal diet.

How is the sample collected for testing?

A blood sample is drawn by needle from a vein in your arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

You may be instructed to fast for 12 hours before the test. In this case, only water is permitted. Morning specimens are preferred.

The Test

How is it used?

The ferritin test is ordered to assess a person's iron stores in the body. The test is sometimes ordered along with an iron test and a TIBC to detect the presence and evaluate the severity of an iron deficiency or overload.

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When is it ordered?

The ferritin test may be ordered, along with other iron tests, when a routine CBC shows that a person's hemoglobin and hematocrit are low and their red blood cells are smaller and paler than normal (microcytic and hypochromic), suggesting iron deficiency anemia even though other clinical symptoms have not yet developed.

Early iron deficiency usually causes no physical effects at all. If a person is otherwise healthy, symptoms seldom appear before the hemoglobin in the blood drops below a certain level (10 g per deciliter). However, as the iron-deficiency progresses, symptoms may begin to develop and a doctor may order ferritin as wells as other iron-related tests. The most common symptoms of iron deficiency anemia include:

Chronic fatigue/tiredness
Weakness
Dizziness
Headaches

As iron stores continue to be depleted, there may be shortness of breath, ringing in the ears (tinnitus), drowsiness, and irritability. If the anemia progresses in severity, chest pain, headaches, leg pains, shock, and even heart failure may occur. Children may develop learning (cognitive) disabilities. Besides the general symptoms of anemia, there are certain symptoms that are characteristic of iron deficiency. These include pica (cravings for specific substances, such as licorice, chalk, dirt, or clay), a burning sensation in the tongue or a smooth tongue, sores at the corners of the mouth, and spoon-shaped finger- and toe-nails.

A ferritin level may also be ordered when iron overload is suspected. Symptoms of iron overload will vary from person to person and tend to worsen over time. They are due to iron accumulation in the blood and tissues. Symptoms may include:

Joint pain
Fatigue, weakness
Lack of energy
Abdominal pain
Loss of sex drive
Heart problems

To confirm the presence of iron overload, other iron tests (iron, TIBC) and a genetic test for hereditary hemochromatosis may be ordered as well.

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What does the test result mean?

Ferritin levels are often evaluated in conjunction with other iron tests. A summary of the changes in iron tests seen in various diseases of iron status is shown in the table below.

Disease	Iron	TIBC/Transferrin	UIBC	%Transferrin Saturation	Ferritin
Iron Deficiency	Low	High	High	Low	Low
Hemochromatosis	High	Low	Low	High	High
Chronic Illness	Low	Low	Low/Normal	Low	Normal/High
Hemolytic Anemia	High	Normal/Low	Low/Normal	High	High
Sideroblastic Anemia	Normal/High	Normal/Low	Low/Normal	High	High
Iron Poisoning	High	Normal	Low	High	Normal

Ferritin levels are low in people who have iron deficiency and are elevated in those with hemochromatosis and other excess iron storage disorders and in those who have had multiple blood transfusions.

Ferritin is an acute phase reactant and thus may be increased in people with inflammation, liver disease, chronic infection, autoimmune disorders, and some types of cancer. Ferritin is not typically used to detect or monitor these conditions.

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Is there anything else I should know?

Normally, most ferritin is found inside of cells with only a small amount in the blood. When there is damage to organs that contain ferritin, such as the liver, spleen, and bone marrow, ferritin levels can become elevated even though the total amount of iron in the body is normal.

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Common Questions

1. My iron level is normal, but my ferritin level is low. Why is that?

The development of iron-deficiency anemia is a gradual process. If your body is not taking in enough iron, your body first uses the iron that is stored in tissues (i.e., ferritin) and blood levels of ferritin will begin to decrease. If not corrected, the stored iron begins to be depleted as it is used in the production of red blood cells. In the early stages of iron-deficiency, blood levels of iron can be normal while stored iron, and therefore ferritin levels, will begin to decrease.

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2. I know eating foods high in iron or taking iron supplements will increase my iron level but will it also increase my ferritin level?

Yes. Taking in more iron will increase the level of iron in your body. If the level of iron in your body increases and is more than your body requires, then your body will begin to store more iron in the form of ferritin.

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3. What other conditions may alter ferritin levels?

Increased levels may be seen in alcohol abuse, acute hepatitis, and infections.

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4. Who should take iron supplements?

The people who typically need iron supplements are pregnant women and patients with documented iron deficiency. Young women who become anemic due to poor dietary intake and and/or excessive loss of blood during the menstrual cycle may require iron supplements. People should not take iron supplements before talking to their doctor as excess iron can cause chronic iron overload. An overdose of iron pills can be toxic, especially to children.

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5. Is there any way to cure iron overload?

If it is due to a temporary condition or ingestion of iron supplements, then it will likely resolve on its own once the condition or supplement ingestion is resolved. If it is due to hemochromatosis or to a chronic disease, then it cannot be cured; careful management by your physician is required. In severe cases, periodic removal of a prescribed amount of blood, also known as therapeutic phlebotomy, may be necessary.

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Gersten, T. (Updated 2009 January 12). Ferritin. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003490.htm. Accessed June 2009.

(Modified 2009 March 13). About Iron. Iron Disorders Institute [On-line information]. Available online at http://www.irondisorders.org/Disorders/about.asp through http://www.irondisorders.org. Accessed June 2009.

(Updated 2007 August 24). Dietary Supplement Fact Sheet: Iron. NIH Office of Dietary Supplements [On-line information]. Available online at http://ods.od.nih.gov/factsheets/iron.asp through http://ods.od.nih.gov. Accessed June 2009.

Rathz, D. et. al. (Updated 2009 February 02). Toxicity, Iron. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/166933-overview through http://emedicine.medscape.com. Accessed June 2009.

Chen, Y. (Updated 2009 April 05). Iron Deficiency Anemia. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm. Accessed June 2009.

Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson RA and Pincus MR, eds. Philadelphia: 2007, Pg 506.

Sources Used in Previous Reviews

Corbett, JV. Laboratory Tests & Diagnostic Procedures with Nursing Diagnoses, 4th ed. Stamford, Conn.: Appleton & Lang, 1996. Pp. 34-35, 41-43.

Frey, Rebecca J. Iron Tests. Chapter in: Gale Encyclopedia of Medicine, Edition One, 1999 Gale Research Group, Pg. 1648.

Witte DL, Crosby WH, Edwards CQ, Fairbanks VG, Mitros FA: Practice guideline development task force of the College of American Pathologists.

Boston University Medical Center: Community Outreach Health Information System. Available online at http://www.bu.edu/cohis/cardvasc/blood/anemia.htm#prevent through http://www.bu.edu.

Lyon, Elaine and Frank, Elizabeth L. Hereditary Hemochromatosis Since Discovery of the HFE Gene. Clinical Chemistry 47:1147-1156 (Jul 2001).