Ferritin

Ferritin is a protein that helps your body store iron. Think of it like a tiny, safe storage unit for iron within your cells. Most of this stored iron is found in your liver, spleen, and bone marrow. The amount of ferritin in your blood gives a good indication of how much iron your body has stored overall.

What it is

Ferritin is a protein complex that acts as the primary way your body stores iron. Iron is an essential mineral that your body needs to make haemoglobin, the protein in red blood cells that carries oxygen around your body. It's also important for many other bodily functions, including energy production and immune system health.

When you have enough iron, your body stores the excess as ferritin. If your iron levels drop, your body can then release this stored iron from ferritin to use as needed. The ferritin level measured in a blood test reflects the amount of iron stored in your body's tissues. In the UK, a typical reference range for ferritin in adults is generally between 20 and 300 micrograms per litre (µg/l), though this can vary slightly between laboratories.

Why it matters

Measuring ferritin levels is a crucial way for doctors to assess your body's iron status. It's often considered the most sensitive indicator of iron deficiency, even before other signs like low haemoglobin levels appear.

• Detecting Iron Deficiency: Low ferritin levels can indicate that your body's iron stores are depleted. This is the earliest stage of iron deficiency, which can eventually lead to iron deficiency anaemia if left unaddressed. Anaemia means you don't have enough healthy red blood cells to carry adequate oxygen to your body's tissues, which can cause fatigue and other symptoms.
• Monitoring Iron Overload: High ferritin levels can sometimes suggest that your body is storing too much iron. This condition, known as iron overload or hemochromatosis, can potentially damage organs like the liver, heart, and pancreas over time.
• Assessing Inflammation: Ferritin is also an acute-phase reactant, meaning its levels can rise in response to inflammation or infection in the body, even if iron stores are normal or low. This is important to consider when interpreting test results.

What can cause it to be high or low

Several factors can influence your ferritin levels:

Low Ferritin Levels can be associated with:

• Iron Deficiency: This is the most common reason for low ferritin. It can occur due to insufficient iron intake in the diet, poor absorption of iron from food, or blood loss.
• Blood Loss: Chronic blood loss, such as from heavy menstrual periods, gastrointestinal bleeding (e.g., from ulcers or polyps), or frequent blood donation, can deplete iron stores.
• Pregnancy: Increased iron demands during pregnancy can lead to lower ferritin levels.
• Coeliac Disease: This condition can affect the absorption of nutrients, including iron.
• Certain Medical Conditions: Conditions affecting the gut or leading to chronic inflammation can sometimes impact iron absorption or increase iron loss.

High Ferritin Levels can be associated with:

• Iron Overload (Hemochromatosis): This is a genetic condition where the body absorbs too much iron from the diet.
• Liver Disease: Conditions like hepatitis or cirrhosis can affect how the liver processes and stores iron.
• Inflammation and Infection: As mentioned, ferritin can rise during periods of inflammation, infection, or certain types of cancer.
• Alcohol Abuse: Excessive alcohol consumption can damage the liver and affect iron metabolism.
• Frequent Blood Transfusions: Receiving multiple blood transfusions can lead to an accumulation of iron.
• Certain Anaemias: Some types of anaemia, other than iron deficiency anaemia, can be associated with high ferritin.

Lifestyle factors that may help

If your ferritin levels are low due to dietary factors, certain lifestyle adjustments might be discussed with your GP:

• Dietary Iron Intake: Including iron-rich foods in your diet is key. Good sources include red meat, poultry, fish, beans, lentils, spinach, and fortified cereals. Discussing your diet with a healthcare professional or a registered dietitian can be helpful.
• Vitamin C: Consuming foods rich in vitamin C (like citrus fruits, berries, and bell peppers) alongside iron-rich foods can enhance iron absorption.
• Avoiding Inhibitors: Certain substances can hinder iron absorption. These include tea and coffee (tannins) and calcium-rich foods or supplements. It might be helpful to consume these separately from iron-rich meals.

If your ferritin levels are high, lifestyle changes are usually secondary to addressing the underlying cause, which your GP will investigate.

Questions to discuss with your GP

If you have had a ferritin test or are concerned about your iron levels, here are some questions you might consider discussing with your GP:

• What does my ferritin result mean in the context of my overall health?
• Could my symptoms be related to my ferritin level?
• What are the potential causes for my ferritin level being high or low?
• Are there any further tests needed to understand my iron status or the reason for the abnormal ferritin level?
• If my ferritin is low, what dietary changes or further investigations might be recommended?
• If my ferritin is high, what are the next steps for diagnosis and management?