What factors could contribute to high ferritin levels?

Question

Hello doctor,

Last October, on a routine physical, I received a ferritin reading of 535, with all other CBC/metabolic panel tests and the iron panel completely normal. A follow-up six weeks later still showed a raised ferritin of 448, and yet another showed two weeks after that at 575 (at the time of the 575 value, my CRP was normal, less than .4, and my ESR was 2 mm/hr). I was referred to a hematologist who, one week later, did a ferritin test (different lab), and my result came back at 341, and one month later, at 368.

My TIBC averages around 269 and iron around 108. TS % is usually 39%. The hematologist also tested me for the HFE gene, and this was negative. ANA negative, various viruses like hepatitis, and did another ESR, which came back at 4 mm/hr. I had an abdominal ultrasound that was unremarkable with the exception of some renal cysts and repeated metabolic panels and CBCs with normal results.

I am a 42-year-old very fit male with a BMI of around 24. I aminvolved in boxingand other contact sports so not sure if this could be a factor. Can ferritin increase from an injured swollen elbow or osteoarthritis? Is there much variation amongst lab results measuring ferritin (575 down to 341 in six days seems like a lot)?

I am trying to get to the bottom of these results. I have no real symptoms of other diseases. I notice some labs quote a high of 300 as normal for a man, others 400, and a website indicates even a value of 500 is normal. Could this level just be normal for me? If not, what is the most likely underlying issue? I can provide more info as needed.

Could my levels be a result of something serious considering the normal CRP, ESR, ANA, and other blood work? Any other workup to be done other than follow-up to check levels? One other thing, I do consume four to five meals per day and do eat iron-rich foods.

Could this be a factor considering the data I presented?

Any other info you need?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Ferritin levels can vary from lab to lab. It also has a variation based on fasting status and the time of day when the sample is taken. Your ferritin levels are not alarmingly high. All the major workups are done and negative.

Avoid alcohol intake if any.

Your BMI is slightly above normal. Your USG does not suggest fatty liver, but I would suggest a fibroscan or USG elastography, as it can pick up early fatty liver, which can also cause a slight increase in ferritin. Regular red meat intake can also cause a slight increase in ferritin.

Osteoarthritis and old injuries over the elbow have no relation to high ferritin.

Your condition is not serious; as a part of finishing your workup, you can get a FibroScan of the liver and follow up on ferritin levels from the same lab every six months. Preferably give the samples at the same time of day.

For more information, consult an internal medicine physician online.

Answer 2

Hello,

Welcome back to icliniq.com.

An increased ferritin level above baseline (which itself can vary from person to person and exhibit diurnal variations, etc.) indicates some inflammation is occurring in the body. Yes, a viral infection or acute injury can increase your ferritin level.

Unless your elbow is chronically infected or has chronic arthritis, it is unlikely to cause high ferritin.

Do not worry about malignancy. Ferritin is never used as a marker for malignancy; associations with malignancy are infrequent. I would not worry about it.

If you have any chronic joint pains or if your elbow has been constantly aching for a long time, the only other possibility to consider would be some form of chronic arthritis, which can be evaluated by a rheumatologist close to you.

Since hemochromatosis has been ruled out, you can have a regular diet with adequate iron intake.

For more information consult an internal medicine physician online.