Ferritin

Differential Diagnosis (elevated)

• Iron overload
  • Primary
    • Hereditary hemochromatosis
  • Secondary
    • Repeat blood transfusion
    • Intravenous iron (especially when used in renal failure or cancer)
    • Iron supplementation
    • Thalassemia intermedia, sideroblastic anemia, chronic hemolytic anemia
    • Porphyria cutanea tarda
• Without iron overload
  • Liver disease (including NASH and viral hepatitis)
  • Alcohol excess
  • Acute or chronic inflammation
  • Infections
  • Malignancy
  • Renal failure
  • Metabolic syndrome
  • Thyrotoxicosis
  • Acute MI

Investigations

• CBC with ESR/CRP for infection, inflammation, and anemia
• Liver panel +/- liver ultrasound
  • Hepatitis B and C serologies
• Electrolytes and creatinine for renal function
• Glucose, A1c, and lipid panel for metabolic syndrome
• Transferrin saturation, for true iron overload
  • C282Y genotyping if suspecting hereditary hemochromatosis
  • Consider MR liver or liver biopsy