Causes of an elevated serum Ferritin

The interpretation of an elevated serum ferritin requires consideration of several separate disease categories. These come under the broad headings of:

  • Iron overload
  • Acute inflammatory conditions
  • Liver disease
  • Alcohol excess
Causes of iron overload
  • Primary
    • Hereditary haemochromatosis
    • Hereditary aceruloplasminemia (Wilson’s disease)
  • Secondary
    • Transfusion overload
    • Excess dietary iron
    • Porphyria cutanea tarda
    • Ineffective erythropoiesis (Sideroblastic anaemia, Thalassemia)
  • Causes of high serum ferritin without iron overload
    • Liver disease – non-alcoholic
    • Hepatitic steatosis (NASH)* or viralhepatitis (B/C)
    • Alcohol excess
    • Bacterial infections
    • Fungal infections: i.e. Histoplasmosis
    • Hemophagocytic Syndrome
    • Thyrotoxicosis
    • Malignancy (especially haematological)
    • Chronic inflammatory conditions: rheumatoid arthritis, inflammatory bowel disease, etc.