This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Ferritin - explanation how ferritin levels may be raised as an acute phase protein

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • in a healthy person, simple indices of iron status such as ferritin (a storage form of iron predominantly found in the liver, which is detectable in serum as it leaks into the circulation) and transferrin saturation (percentage occupation of iron carrier molecules in the circulation) are sufficient to diagnose iron deficiency


  • however, in the setting of inflammation
    • ferritin levels are increased - ferritin acts as an acute-phase reactant and serum concentration increases - thus in this setting, interpretation of ferritin alone as a measure of iron deficiency becomes unreliable

    • also in response to the same inflammatory process that results in a rise in serum ferritin, a 25-amino acid protein is produced, known as hepcidin
      • functions of hepcidin are:
        • prevention of iron overload through limiting excessive iron absorption in the proximal small intestine and regulation of iron release from macrophages participating in recycling
        • prevention of iron acquisition by pathogens as a component of innate immunity e.g. limits supply to bacteria - iron has several roles within a bacterial cell is required to render active many different proteins and enzymes involved in a variety of metabolic processes; also essential for expression of many key virulence determinants
        • hepcidin expression is usually regulated in a negative feedback loop by systemic levels of iron (5)
          • however, under inflammatory conditions, induction of hepcidin expression can occur

Hepcidin impairs the function of the key iron regulatory protein, ferroportin, thereby preventing the transport of iron across basement membranes - this is the hepcidin-ferroportin axis (1,2,3)

  • inhibits the uptake of iron from the gastrointestinal tract, the transport of stored iron out of the liver, and the reclamation of iron from circulating macrophages
  • ferritin seen in inflammation may be an active player in innate immunity, as opposed to a consequence of cell damage and leakage

Intravenous iron therapy:

  • use of intravenous iron replacement therapy bypasses the hepcidin-ferroportin axis, the treatment has an improved clinical effect in the setting of inflammation, and does not have the same gastrointestinal side effects of oral iron
  • previously parenteral iron preparations were highly labile and prone to the excessive release of free iron into the circulation, with an associated risk of side effects (4)
    • development of newer, high-molecular-weight and more stable preparations has markedly reduced the incidence of these events
    • therefore, administration of parenteral iron is becoming more widespread

Reference:


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.