Ferritin
Ferritin is a water-soluble complex of protein and iron, which circulates in free form in the blood and can be measured in simple samples of serum or plasma. It is a cytosolic molecule comprised of subunits that self-assemble into a nanocage capable of containing up to 4500 iron atoms. [1]
Circulating ferritin is in equilibrium to ferritin molecules contained in histiocytes of the less easily measured bone marrow. In the histiocytes, the ferritin molecules accumulate into large cytoplasmic inclusions of hemosiderin, which is visible under the light microscope. Hemosiderin stains strongly with the Prussian Blue stain of marrow, and, if in sufficient concentration, is visible unstained.
Clinical use
Iron deficiency anemia
The serum ferritin is the best laboratory test for storage of marrow iron.[2][3][4] Other test that have been used are serum iron level, and serum transferrin level. Serum iron varies with individuals and with dietary iron intake, but, the other two parameters mentioned change in an acute phase reaction (ferritin rises and transferrin falls) and thus cannot reliably detect iron deficiency in the presence of inflammation. They also do not measure if the iron is actually available for hematopoiesis. Modern tests that circumvent this problem include soluble transferrin receptor (sTfr), transferrin saturation (TfS or TSAT), the hemoglobin content of reticulocytes or the percentage of hypochromic cells [5]. Most of these can today be readily determined on automated laboratory analysis systems.
| Test | Cutoff value | Likelihood ratio |
|---|---|---|
| Ferritin | ≥ 100 ng/ml | 0.08 |
| Ferritin | < 25 ng/ml | < 8.83 |
| A likelihood ratio > 10 helps establish a diagnosis while a ratio < 0.1 helps exclude a diagnosis.[7] | ||
Iron overload
Other causes of high ferritin levels
Infections and neoplasms can elevate the ferritin over 1,000 ng/mL.[8]
References
- ↑ De Domenico, I et al. (2006), "Ferroportin-mediated mobilization of ferritin iron precedes ferritin degradation by the proteasome", EMBO Journal 25: 5396 - 5404, DOI:10.1038/sj.emboj.7601409
- ↑ Kis AM, Carnes M (July 1998). "Detecting iron deficiency in anemic patients with concomitant medical problems". J Gen Intern Med 13 (7): 455–61. PMID 9686711. PMC 1496985. [e]
- ↑ Guyatt G, Patterson C, Ali M, Singer J, Levine M, Turpie I, Meyer R (1990). "Diagnosis of iron-deficiency anemia in the elderly.". Am J Med 88 (3): 205-9. PMID 2178409.
- ↑ Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C.Laboratory diagnosis of iron-deficiency anemia: an overview.J Gen Intern Med. 19927:145-53. Review. (Erratum in: J Gen Intern Med 1992;7:423) PMID: 1487761
- ↑ Thomas C, Thomas L (2002). "Biochemical Markers and Hematologic Indices in the Diagnosis of Functional Iron Deficiency". Clin Chem 48 (7): 1066-76. PMID 12089176.
- ↑ Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C (1992). "Laboratory diagnosis of iron-deficiency anemia: an overview". J Gen Intern Med 7 (2): 145–53. PMID 1487761. [e]
- ↑ McGee S (August 2002). "Simplifying likelihood ratios". J Gen Intern Med 17 (8): 646–9. PMID 12213147. [e]
- ↑ Lee MH, Means RT (1995). "Extremely elevated serum ferritin levels in a university hospital: associated diseases and clinical significance.". Am J Med 98 (6): 566-71. PMID 7778572. [e]