Ferritin in serum

Ferritin is a water-soluble iron hydroxide complex with an apoferritin protein. It is found in the cells of the liver, selesinka, red bone marrow and reticulocytes. In small amounts, ferritin is present in the serum, where it performs the function of transporting iron from the reticuloendothelial to the parenchymal cells of the liver. Ferritin is the main human protein that deposits iron. Ferritin and hemosiderin contain 15-20% of the total amount of iron in the body. Although serum ferritin is present in small amounts, its concentration reflects iron stores. Reference values ​​of ferritin content in blood serum are presented in Table. Low values ​​of ferritin are the first indicator of reduction of iron stores in the body. Determination of serum ferritin is used to diagnose and monitor iron deficiency or excess, differential diagnosis of anemia.

Table Reference values ​​for serum ferritin concentration

Table Reference values ​​for serum ferritin concentration in the serum

The results of the ferritin test can be false-positive or false-negative in inflammation( ferritin refers to acute phase proteins), tumors, liver pathology, when ferritin content may bebe increased. In a number of cases, patients who are on hemodialysis, have a paradoxically increased level of ferritin in the accumulation of iron in the cells of the reticuloendothelial system. At the same time in the bone marrow can be a simultaneous deficiency of iron. Therefore, in the evaluation of iron metabolism, complex studies should be conducted( Table).

Table Criteria for diagnosis of iron deficiency

Table Criteria for diagnosis of iron deficiency

Negative iron balance for a long time leads to the development of iron deficiency. There are three stages of failure, leading to the most severe form - iron deficiency anemia( Table.).Symptoms and symptoms of the disease in the patient also progress, depending on the presence and extent of anemia.

Table Stages of development of iron deficiency anemia

Table Stages of development of iron deficiency anemia

■ Reduced iron stores( stage 1): iron stores in the bone marrow and liver decrease. Patients do not have any symptoms, the concentration of Hb is within the normal range. The concentration of ferritin in the serum and the amount of iron in the red bone marrow are reduced. The main signs of iron depletion are an increase in its absorption, indicating an increased vulnerability or the possibility of developing iron deficiency.

■ Iron deficiency erythropoiesis( stage 2): the activity of erythropoiesis is reduced due to the lack of iron required for inclusion in the heme part of Hb. The concentration of Hb in the blood begins to decrease, the content of free protoporphyrin in the erythrocytes increases. This stage is also characterized by the absence or decrease in the amount of iron stores, low serum iron concentration, increased OLCF, and low saturation of transferrin. The indices of Ht practically do not differ from normal ones.

■ Iron deficiency anemia( stage 3) - the unfolded stage of the disease. The serum ferritin content and saturation of transferrin are very low. Other laboratory features of this stage include: a decrease in the amount of iron stores, low serum iron concentrations, an increase in OLCs, and a low concentration of Hb.

An increase in serum ferritin levels can be detected in the following diseases: with excess iron content [eg, hemochromatosis( ferritin concentration above 500 μg / l), certain liver diseases), inflammatory processes( pulmonary infections, osteomyelitis, arthritis, SLE,burns), some acute and chronic diseases with liver cells( alcoholic liver damage, hepatitis), breast cancer, acute myeloblastic and lymphoblastic leukemia, and lymphogranulomatosis. When evaluating the results of an elevated ferritin concentration, it should be borne in mind that it refers to the proteins of the acute phase, therefore, its increase can reflect the body's response to the inflammatory process. In such cases, if there is a suspected presence of hemochromatosis, it is necessary to simultaneously determine the concentration of serum iron and OZHS.If the ratio of serum iron to OGSS exceeds 50-55%, then, most likely, the patient has hemochromatosis, and not hemosiderosis.

The determination of ferritin is most important in the diagnosis of iron metabolism disorders. Reduction of ferritin is detected in iron deficiency and hemolytic anemia with intravascular hemolysis. In patients with chronic kidney disease, inadequate accumulation of iron in the body can be ascertained when the serum content of ferritin is below 100 μg / l.