Ferritin, Serum

Ferritin is the major iron storage protein in the body. The serum ferritin test is done to assess the iron stores in the body. The serum ferritin test in combination with an iron test and a TIBC helps to detect the presence and severity of iron deficiency or iron excess. Serum ferritin test is advised when there are non specific symptoms and signs of iron deficiency anaemia such as pallor, weakness, easy fatiguability, breathlessness on exertion, tachycardia, nail changes, and systolic heart murmur. Serum ferritin test is also done when suspecting hemochromatosis with symptoms like Joint pain, abdominal pain, fatigue, weakness etc. There is a direct correlation beween storage iron and serum ferritin levels and therefore estimation of serum ferritin is employed for diagnosis of iron deficiency and iron overload. However serum ferritin test is a non-specific test (as serum ferritin is a acute phase reactant) as the levels of serum ferritin increase in inflammation, neoplastic disorders and liver diseases. Serum ferritin concentration declines very early in the development of iron deficiency even before, changes like haemoglobin concentration, RBCs size or serum iron concentration are observed. Serum ferritin test is a simple and rapid blood test. The levels of serum ferritin are increased in conditions like hemochromatosis, chronic diseases etc., and decreased in conditions like iron deficiency anaemia. Serum ferritin levels are useful to assess the progress of phlebotomy therapy in hemochromatosis or iron overload.

1. What foods can increase iron in the diet?

Meat, egg, green leafy vegetables (such as spinach, collard greens, etc.), wheat germ, whole grain breads and cereals, raisins etc., are rich sources of iron.

2. When serum ferritin levels are low with a normal iron levels, what does it interpret?

Iron deficiency anemia is a gradual process. Initially, the stored form of iron (ferritin) is utilised and if still the iron deficiency is not corrected, the body iron levels start depleting. Hence serum ferritin levels are low with normal iron levels in the early stages of iron deficiency anemia.

3. Does iron deficiency manifest quickly or slowly?

Iron deficiency anemia manifests gradually. Iron stores are slowly used up, when the rate of iron loss exceeds the amount absorbed from the gut. At this initial stage, ferritin levels will be low, but serum iron and TIBC remain normal and there are no signs and symptoms of anemia. In the later stages, serum iron levels decrease, TIBC and transferring levels increase and signs and symptoms of anemia appear along with decreased haemoglobin, decreased RBC indices and change in RBC size.

4. Will consumption of foods high in iron and iron supplements increase increase my ferritin level?

Yes. Iron rich foods and iron supplements increase iron levels and so the body will begin to store more iron as ferritin.

5. What conditions alter serum ferritin levels?

Alcohol abuse, acute hepatitis, infections, inflammations, neoplastic conditions increase serum ferritin levels, as serum ferritin is an acute phase reactant.

6. When are iron supplements required?

Iron supplements are required in pregnancy, those with or suspected iron deficiency, Young women who are anemic due to poor dietary intake and have excessive bleeding during menstrual cycle may require iron supplements.

7. How to cure iron overload?

Temporary iron overload is reversible and requires no treatment. Iron overload due to hemochromatosis or chronic disease may require therapeutic phlebotomy (periodic removal of blood).

8. Does blood donation affect iron levels?

Yes. Every time one unit of blood is donated, the body loses approximately 250 mg of iron. Serum ferritin level dereases with each donation and then returns to normal over time. However other tests such as serum iron and TIBC remain unchanged.

9. When is an iron profile done after iron supplementation?

To check for iron absorption from the gut. However iron profile still remains abnormal in malabsorption which requires treatment.