Everything You Need to Know about Ferritin Levels

Ferritin is a protein that stores iron for your body. Iron is a mineral needed to make hemoglobin—a protein in red blood cells that carries oxygen-rich blood from your lungs to the rest of your internal organs. 

Ferritin, found mainly in your liver, spleen, and bone marrow, ensures that cells have a ready supply of iron for oxygen transport and energy production. Imbalanced ferritin levels can be a sign of an underlying health condition.

How Is Ferritin Tested?

The ferritin test is a blood test that measures ferritin levels in the bloodstream. It can let your healthcare provider know how much iron is in your blood. A healthcare provider can also determine if you have any health conditions related to iron deficiency.

Purpose

The primary purpose of the ferritin test is to evaluate the body's iron levels and diagnose potential health conditions. Iron deficiency anemia is associated with low ferritin levels. Too much iron in your body (hemochromatosis) can lead to certain autoimmune conditions and chronic liver disease, affecting how your body stores iron.

Procedure

To collect a blood sample for the ferritin test, a healthcare provider inserts a needle into a vein in your arm. You may feel a mild stinging sensation when the needle is placed in the arm. The lab will measure the ferritin concentration in your blood.

Your healthcare provider may advise you not to eat or drink for at least 12 hours before the test.

Interpreting Results

Ferritin concentrations are measured in nanograms per milliliter (ng/mL) of blood. Normal ferritin levels range from 15-150 ng/mL for females and 15-200 ng/mL for males globally. Normal ferritin levels for men in the United States may be slightly higher.

Ferritin levels below or above these ranges suggest your body has too little or too much iron, which may indicate an underlying health condition.

Causes and Symptoms of High Ferritin Levels

High ferritin levels suggest that your body is storing too much iron (iron overload) or that you are experiencing systemic inflammation.

Causes of High Ferritin Levels

While high ferritin levels are often associated with chronic conditions, elevated levels can also occur due to short-term illnesses.

Conditions associated with high ferritin levels include: 

• Hemochromatosis: With this condition, the body absorbs and stores too much iron, leading to iron buildup in organs such as the liver, pancreas, and heart. Excess iron can cause organ damage and lead to organ failure if left untreated. Hemochromatosis can be hereditary or occur due to excess iron intake from supplements or frequent blood transfusions. 
• Chronic inflammation: Inflammatory conditions, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (lupus), can lead to high ferritin levels.
• Liver disease: Elevated ferritin levels are common in people with chronic liver diseases, such as cirrhosis, hepatitis, and nonalcoholic fatty liver disease.
• Certain cancers: High ferritin levels are a sign of disease progression in specific cancer types, including Hodgkin's lymphoma, neuroblastoma, breast, kidney, and colorectal cancers.
• Acute illness: Acute infectious illnesses, such as influenza, bacterial pneumonia, COVID-19, and Epstein-Barr virus infections, can cause a temporary rise in ferritin levels as inflammation increases while your body fights the infection.

Symptoms of High Ferritin Levels 

You may not always notice signs of high ferritin levels, but some conditions that cause elevated ferritin can cause symptoms.

Symptoms associated with high ferritin from iron overload include: 

• Fatigue
• Low libido 
• Erectile dysfunction
• Abdominal pain 
• Joint pain, especially in the knees and hands
• Weakness
• Gray, metallic, or bronze-colored skin

Causes and Symptoms of Low Ferritin Levels

Low ferritin levels typically indicate the body's iron stores are too low. Low iron can cause anemia or indicate an underlying condition affecting how your body stores or uses iron. 

Causes of Low Ferritin Levels

Several lifestyle factors and underlying conditions can contribute to low ferritin levels, including:

• Iron deficiency anemia: Iron deficiency anemia occurs when the body lacks sufficient iron to produce hemoglobin, a vital protein in red blood cells that carries oxygen throughout your body. 
• Inadequate iron intake: A diet low in iron-rich foods (e.g., red meat, beans, leafy greens) can lead to low ferritin levels over time, especially in people with higher iron needs, such as pregnant people or growing children.
• Chronic blood loss: Conditions that cause ongoing blood loss, such as peptic ulcers, colorectal cancer, or heavy menstrual bleeding, can deplete iron and ferritin levels.
• Inflammation: Chronic inflammatory conditions can affect how your body uses or stores iron, leading to low circulating ferritin levels.
• Malabsorption: Conditions like celiac disease, Crohn's disease, or other gastrointestinal conditions can impair your body's ability to absorb iron—even if dietary intake is sufficient.
• Pregnancy: During pregnancy, the body requires significantly more iron. If your iron intake does not meet this increased demand, ferritin levels can drop even lower.

Symptoms of Low Ferritin Levels

When ferritin levels are low, the body struggles to meet its iron needs. Low iron means your body cannot deliver enough oxygen-rich blood to its tissues and organs, leading to symptoms such as:

• Fatigue
• Shortness of breath
• Arrhythmia (irregular heartbeat) 
• Weakness 
• Pale or yellowish skin
• Headaches, especially during physical activity 
• Pounding or "whooshing" sounds in the ears
• Craving ice or clay
• Brittle, weak nails
• Hair loss

Treatment for Abnormal Ferritin Levels

Treatment for abnormal ferritin levels focuses on addressing the underlying cause to restore the body's iron levels. Treatment depends on whether ferritin and iron levels are too high or low. 

Treatment for High Ferritin Levels

When ferritin levels are too high, treatment aims to reduce iron levels. Common treatments include: 

• Phlebotomy (therapeutic blood removal): Regular blood removal, similar to donating blood, is a standard treatment for hemochromatosis. Removing blood reduces iron levels in your body, preventing iron buildup in your organs like the liver and heart. 
• Iron chelation therapy: Iron chelation therapy involves medications delivered subcutaneously (through a vein) like Desferal (deferoxamine) or oral medications like Exjade and Jadenu (deferasirox) that help remove excess iron in your blood.

Treatment for Low Ferritin Levels

Treatment for low ferritin levels addresses iron deficiency by replenishing the body's iron stores. Treatment options include:

• Iron supplements: Oral iron supplements, typically containing compounds like ferrous sulfate, ferrous gluconate, or ferrous fumarate, are the most common treatment for low iron and ferritin levels. You may need to take iron supplements over several months to rebuild the iron storage in your body. 
• Intravenous (IV) iron: Intravenous iron can help restore iron levels in people with severe iron deficiency anemia or conditions associated with chronic bleeding or low iron. You may need one or a few IV iron treatment sessions, depending on how low your levels are. 
• Blood transfusions: If your iron levels are dangerously low, a blood transfusion from a blood donor can quickly increase red blood cells and iron levels. 
• Medications: Erythropoiesis stimulating agents (ESA), such as Epogen (epoetin alfa) and Aranesp (darbepoetin alfa), stimulate the bone marrow to produce more red blood cells. Your healthcare provider may prescribe ESAs if you have chronic kidney failure or when treatment for another condition, like cancer, is causing iron deficiency anemia. 
• Dietary changes: Increasing your intake of iron-rich foods (e.g., lean red meat, poultry, salmon, beans, lentils, tofu) can help raise iron and ferritin levels. Vitamin C-rich foods (e.g., citrus fruits, bell peppers, broccoli) can also help improve iron absorption.

How To Prevent Abnormal Ferritin Levels

Ferritin concentration in the blood is the primary way a healthcare provider can check iron levels. Preventing abnormal ferritin levels involves managing iron intake and absorption. Adopting healthy habits can support balanced iron and ferritin levels.

Steps you can take to keep your ferritin levels balanced include:

• Regular checkups: Keep up with routine blood tests to check your iron and ferritin levels, especially if you have a personal or family history of conditions like hemochromatosis or anemia. 
• Monitor and treat chronic conditions: Conditions like rheumatoid arthritis, celiac disease, liver disease, or kidney disease can affect ferritin levels. Manage these conditions by following your treatment plan to help prevent ferritin fluctuations.
• Avoid excessive iron supplementation: Taking iron supplements can lead to iron overload for people without an iron deficiency. It's important to take supplements only when recommended by a healthcare provider.
• Limit alcohol consumption: Excessive alcohol intake can damage the liver, where iron is stored. Reducing alcohol intake supports liver health and can help prevent abnormal ferritin levels.
• Dietary changes: Follow your healthcare provider's recommendations for maintaining a balanced iron intake. Getting iron from diverse sources, such as lean red meat, salmon, beans, lentils, and leafy green vegetables, is ideal for most people.

Those at risk of iron overload can reduce iron absorption by increasing calcium intake, limiting iron-enriched foods, and consuming polyphenol-rich foods and beverages like black tea, nuts, and berries. 

A Quick Review

Ferritin is a protein that binds to and stores iron. Your healthcare provider can use a ferritin blood test to evaluate iron levels in your body. Ferritin levels that are too high or low may indicate an underlying health condition.

There are dietary changes you can make to increase or lower iron levels. Treatments for abnormal ferritin levels may include eating iron-rich foods like lean salmon, leafy green vegetables, and beans. Consult your healthcare provider for a treatment plan if you are experiencing iron deficiency.