Extremely elevated serum ferritin levels in a university hospital: Associated diseases and clinical significance

  • Mark H. Lee
    From the Diagnostic Hematology Laboratory, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Robert T. Means Jr.
    Requests for reprints should be addressed to Robert T. Means, Jr., MD, Division of Hematology/Oncology (ML 562), University of Cincinnati College of Medicine, 231 Bethesda Avenue, Cincinnati, Ohio 45267-0562.
    From the Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
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      To establish the frequency with which serum ferritin levels ≥ 1,000 ng/mL occur in a general hospital population, and to determine the clinical significance of this finding.

      patients and methods

      All serum ferritin determinations performed between June 1992 and July 1993 at the University of Cincinnati Medical Center were reviewed and patients with serum ferritin levels ≥ 1,000 ng/mL identified. The medical records of these patients were then reviewed.


      Of 1,826 serum ferritin determinations performed during the study period, 122 (6.7%) were ≥1,000 ng/mL. Associated clinical syndromes found in the 95 patients with serum ferritin ≥1,000 ng/mL included liver disease (20.0%), renal disease (17.9%), malignant disease (17.9%), human immunodeficiency virus (HIV) infection (16.8%), non-HIV systemic infections (15.8%), chronic transfusions (10.5%), and sickle cell syndromes (10.5%). No syndrome usually associated with extreme serum ferritin elevations was identified in 8.4% of patients, and 16.8% of the patients fell into more than one category. The highest mean serum ferritin levels occurred in the chronically transfused and sickle cell groups. Concomitant serum transferrin saturation values were determined with 82 (86.3%) of the elevated serum ferritin levels and did not correlate well with them. The highest mean transferrin saturation levels occurred in the liver disease group. Transferrin saturation ≥50%, suggestive of iron overload, was significantly more frequent in the liver disease group (P = 0.002); and saturation ≤15%, suggestive of iron- deficient erythropoiesis, was significantly more frequent in the HIV group (P = 0.001).


      Outside the setting of clinical syndromes associated with iron overload (liver disease, transfusions, sickle cell syndromes), serum ferritin levels ≥1,000 ng/mL serve as a nonspecific marker for a variety of significant disorders, including infectious and neoplastic diseases. Further study of the regulation of ferritin production may provide insight into the pathogenesis of disorders associated with extreme serum ferritin elevations.
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