Causes of Hyperferritinemia - Differential Diagnosis

Ferritin > 1000

Ferritin is the storage form of iron. Increased hepcidin prevents ferritin from leaving enterocytes, hepatocytes, and macrophages to be used by the bone marrow. Decreased hepcidin levels will cause increased GI absorption of iron. Hepcidin is made in the liver.

Most Common Causes Ferritin > 1000:

 1. Malignancy - 24%

 2. Iron overload - 22%

 3. Hepatocellular injury - 17%

 4. Infection -16%

 5. Renal -15%

 6. AOCI -1%

 7. HLH or Adult Onset Still's - 1%

Most Common Causes Ferritin > 50000:

 1. Renal failure - 65%

 2. Hepatocellular Injury - 54%

 3. Infection - 46%

 4. Hematologic Malignancy - 32%

Pearls:

 1. Check the iron saturation to differentiate iron overload from inflammatory causes of elevated ferritin.

 2. Sideroblastic anemia due to alcohol use can mimic hemochromatosis.

 3. In adults, HLH is an uncommon cause of extreme ferritin elevation



Dr. Ann Marie Kumfer @AnnKumfer



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