Jump to ContentJump to Main Navigation
Show Summary Details

Open Medicine

formerly Central European Journal of Medicine

IMPACT FACTOR increased in 2015: 0.190
5-year IMPACT FACTOR: 0.221

SCImago Journal Rank (SJR) 2015: 0.140
Source Normalized Impact per Paper (SNIP) 2015: 0.154
Impact per Publication (IPP) 2015: 0.197

Open Access
See all formats and pricing

Select Volume and Issue


Significance of extremely elevated ferritin level in medical inpatients

1Department of Medicine, Carmel Medical Center, Haifa, Israel

2Harvard Clinical Research Institute, Boston, MA, USA

3The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

© 2013 Versita Warsaw. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. (CC BY-NC-ND 3.0)

Citation Information: Open Medicine. Volume 9, Issue 1, Pages 115–120, ISSN (Online) 2391-5463, DOI: 10.2478/s11536-013-0256-4, February 2014

Publication History

Published Online:


The diagnostic and prognostic utility of extremely elevated ferritin values in hospitalized medical patients is lacking. We aimed to determine the clinical significance of ferritin levels ≥ 1000 ng/mL in adults hospitalized in the general medical service. We scanned the hospital laboratory database for ferritin values ≥ 1000 ng/mL, and evaluated the medical history, diagnoses, and survival of patients hospitalized in the general medical service. We compared the characteristics and outcomes of patients with values up-to versus above 2,999 ng/mL. Ferritin samples ranging from 1,003 to 12,170 ng/mL from 422 patients in the lower and 94 in the higher ferritin groups were included. Malignancy, repeat blood transfusions and recent chemotherapy were more prevalent in the higher ferritin group (p=0.003, p=0.002, and p<0.001, respectively). Infection (58.7%), chronic kidney disease (22.0%), and solid or hematological malignancies (21.6% and 17.1%, respectively) were the leading conditions associated with elevated ferritin. One-year survival was low, and significantly lower in patients in the higher ferritin group (10.8% vs. 16.9%, p=0.004). In conclusion, extremely elevated ferritin values in patients admitted to the general medical service are associated with multiplicity of clinical conditions and poor outcome.

Keywords: Internal Medicine; Ferritin; Differential Diagnosis; Prognosis

  • [1] Valberg LS. Plasma ferritin concentrations: their clinical significance and relevance to patient care. Canadian Medical Association journal. 1980 Jun 7;122(11):1240–1248. PubMed PMID: 6992966. Pubmed Central PMCID: 1802038. Epub 1980/06/07. eng

  • [2] Finch CA, Bellotti V, Stray S, Lipschitz DA, Cook JD, Pippard MJ, et al. Plasma ferritin determination as a diagnostic tool. The Western journal of medicine. 1986 Nov;145(5):657–663. PubMed PMID: 3541387. Pubmed Central PMCID: 1307110. Epub 1986/11/01. eng

  • [3] Olynyk JK, Cullen DJ, Aquilia S, Rossi E, Summerville L, Powell LW. A population-based study of the clinical expression of the hemochromatosis gene. The New England journal of medicine. 1999 Sep 2;341(10):718–724. PubMed PMID: 10471457. Epub 1999/09/02. eng http://dx.doi.org/10.1056/NEJM199909023411002

  • [4] McLaren CE, McLachlan GJ, Halliday JW, Webb SI, Leggett BA, Jazwinska EC, et al. Distribution of transferrin saturation in an Australian population: relevance to the early diagnosis of hemochromatosis. Gastroenterology. 1998 Mar;114(3):543–549. PubMed PMID: 9496946. Epub 1998/03/13. eng http://dx.doi.org/10.1016/S0016-5085(98)70538-4

  • [5] Adams PC, Barton JC. A diagnostic approach to hyperferritinemia with a non-elevated transferrin saturation. Journal of hepatology. 2011 Aug;55(2):453–458. PubMed PMID: 21354228. Epub 2011/03/01. eng http://dx.doi.org/10.1016/j.jhep.2011.02.010

  • [6] Lee MH, Means RT, Jr. Extremely elevated serum ferritin levels in a university hospital: associated diseases and clinical significance. The American journal of medicine. 1995 Jun;98(6):566–571. PubMed PMID: 7778572. Epub 1995/06/01. eng http://dx.doi.org/10.1016/S0002-9343(99)80015-1

  • [7] Nirel N, Rosen B, Sharon A, Blondheim O, Sherf M, Samuel H, et al. The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments. International journal of medical informatics. 2010 Sep;79(9):649–657. PubMed PMID: 20655276. Epub 2010/07/27. eng http://dx.doi.org/10.1016/j.ijmedinf.2010.06.005 [Web of Science]

  • [8] Hearnshaw S, Thompson NP, McGill A. The epidemiology of hyperferritinaemia. World journal of gastroenterology: WJG. 2006 Sep 28;12(36):5866–5869. PubMed PMID: 17007054. Epub 2006/09/29. eng

  • [9] Song MK, Chung JS, Seol YM, Shin HJ, Choi YJ, Cho GJ. Elevation of serum ferritin is associated with the outcome of patients with newly diagnosed multiple myeloma. The Korean journal of internal medicine. 2009 Dec;24(4):368–373. PubMed PMID: 19949737. Pubmed Central PMCID: 2784982. Epub 2009/12/02. eng http://dx.doi.org/10.3904/kjim.2009.24.4.368

  • [10] Hann HW, Evans AE, Siegel SE, Wong KY, Sather H, Dalton A, et al. Prognostic importance of serum ferritin in patients with Stages III and IV neuroblastoma: the Childrens Cancer Study Group experience. Cancer research. 1985 Jun;45(6):2843–2848. PubMed PMID: 3986811. Epub 1985/06/01. eng

  • [11] Milman N, Pedersen LM. The serum ferritin concentration is a significant prognostic indicator of survival in primary lung cancer. Oncology reports. 2002 Jan–Feb;9(1):193–198. PubMed PMID: 11748482. Epub 2001/12/19. eng

  • [12] Bertola F, Veneri D, Bosio S, Battaglia P, Disperati A, Schiavon R. Hyperferritinaemia Without Iron Overload: Pathogenic and Therapeutic Implications Current Drug Targets-Immune, Endocrine & Metabolic Disorders. 2004;4(2):93–105

  • [13] Schwarz-Eywill M, Heilig B, Bauer H, Breitbart A, Pezzutto A. Evaluation of serum ferritin as a marker for adult Still’s disease activity. Annals of the rheumatic diseases. 1992 May;51(5):683–685. PubMed PMID: 1616341. Pubmed Central PMCID: 1005709. Epub 1992/05/01. eng http://dx.doi.org/10.1136/ard.51.5.683

  • [14] Novak S, Anic F, Luke-Vrbanic TS. Extremely high serum ferritin levels as a main diagnostic tool of adult-onset Still’s disease. Rheumatology international. 2012 Apr;32(4):1091–1094. PubMed PMID: 21359498. Epub 2011/03/02. eng http://dx.doi.org/10.1007/s00296-011-1834-x [Web of Science]

  • [15] Kirn DH, Fredericks D, McCutchan JA, Stites D, Shuman M. Marked elevation of the serum ferritin is highly specific for disseminated histoplasmosis in AIDS. AIDS. 1995 Oct;9(10):1204–1205. PubMed PMID: 8519465. Epub 1995/10/01. eng http://dx.doi.org/10.1097/00002030-199510000-00020

  • [16] Visser A, van de Vyver A. Severe hyperferritinemia in Mycobacteria tuberculosis infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2011 Jan 15;52(2):273–274. PubMed PMID: 21288855. Epub 2011/02/04. eng http://dx.doi.org/10.1093/cid/ciq126

  • [17] Ramirez C, Rubio C, Fernandez de la Puebla RA, Aguilera C, Espejo I, Fuentes F. [Clinical significance of increased serum ferritin levels]. Medicina clinica. 2004 Apr 17;122(14):532–534. PubMed PMID: 15117645. Epub 2004/05/01. Significado clinico de los valores elevados de ferritina serica. spa

Comments (0)

Please log in or register to comment.