Causes of elevated ferritin levels

Dr Mark Crowther is a professor and chair of the Department of Medicine and the Leo Pharma Chair in Thromboembolism Research at McMaster University.

What diseases can cause elevated ferritin levels?

Mark Crowther, MD, MSc: Elevated ferritin levels can be caused by anything that causes hepatic injury or systematic inflammation. The most important message is that, unless you have a very strong reason, you should not be measuring ferritin levels in hospitalized patients or in patients who are otherwise sick.

One of the common questions we get asked is about a situation with a 58-year-old woman who has very bad rheumatoid arthritis and a microcytic anemia. Her ferritin level is measured. If the ferritin level comes back at 2 microg/L, that is helpful, because that means she has iron deficiency anemia. But if she has active rheumatoid arthritis, her ferritin level is likely to be 110, 150, 200, or 300 microg/L, and it has lost its predictive ability.

When you do a ferritin level, you should do it with knowledge of the potential factors that will cause it to be appropriately low, so reliably low, or falsely high. Do not get confused by the fact that a ferritin level of 300 microg/L in a patient with an active inflammatory disease does not tell you anything useful about their iron status.