Last updated on 16th Oct 2021 - By Dwayne Michaels

How Abnormal FERRITIN affects heart?

Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure. But before proceeding further let us first know a little about Ferritin.

Ferritin is a protein that stores iron. Red blood cells need iron to form normally and carry oxygen around your body. Other parts of your body, such as your liver, bone marrow, and muscles, also need iron.

Blood test

Ferritin is present in every cell type. It serves to store iron in a non-toxic form, to deposit it in a safe form, and to transport it to areas where it is required. The function and structure of the expressed ferritin protein varies in different cell types.

This is controlled primarily by the amount and stability of messenger RNA, but also by changes in how the mRNA is stored and how efficiently it is transcribed.

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One major trigger for the production of many ferritins is the mere presence of iron; an exception is the yolk ferritin of Lymnaea sp., which lacks an iron-responsive unit.

Free iron is toxic to cells as it acts as a catalyst in the formation of free radicals from reactive oxygen species via the Fenton reaction. Hence vertebrates have an elaborate set of protective mechanisms to bind iron in various tissue compartments.

Within cells, iron is stored in a protein complex as ferritin or the related complex hemosiderin.

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Apoferritin binds to free ferrous iron and stores it in the ferric state. As ferritin accumulates within cells of the reticuloendothelial system, protein aggregates are formed as hemosiderin.

Iron in ferritin or hemosiderin can be extracted for release by the RE cells, although hemosiderin is less readily available. Under steady-state conditions, the level of ferritin in the blood serum correlates with total body stores of iron; thus, the serum ferritin FR5Rl is the most convenient laboratory test to estimate iron stores.

What if Ferritin is Low:

  • If the ferritin level is low, there is a risk for lack of iron, which could lead to anemia or iron deficiency without anemia.
  • Low ferritin may also indicate hypothyroidism, vitamin C deficiency or celiac disease.

In the setting of anemia, low serum ferritin is the most specific lab finding for iron-deficiency anemia.

However it is less sensitive, since its levels are increased in the blood by infection or any type of chronic inflammation, and these conditions may convert what would otherwise be a low level of ferritin from lack of iron, into a value in the normal range. For this reason, low ferritin levels carry more information than those in the normal range.

Vegetarianism is not a cause of low serum ferritin levels, despite the common myth. The Position of the ADA pointed this out in 2009 stating, “Incidence of iron-deficiency anemia among vegetarians is similar to that of non-vegetarians.

Although vegetarian adults have lower iron stores than non-vegetarians, their serum ferritin levels are usually within the normal range."

Low serum ferritin levels are seen in some patients with restless legs syndrome, not necessarily related to anemia, but perhaps due to low iron stores short of anemia. A falsely low blood ferritin is very uncommon, but can result from a hook effect of the measuring tools in extreme cases.

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What if Ferritin is High:

If ferritin is high, there is iron in excess or else there is an acute inflammatory reaction in which ferritin is mobilized without iron excess. For example, ferritins may be high in infection without signaling body iron overload.

As ferritin is also an acute-phase reactant, it is often elevated in the course of disease. A normal C-reactive protein can be used to exclude elevated ferritin caused by acute phase reactions.

Ferritin is also used as a marker for iron overload disorders, such as hemochromatosis or hemosiderosis. Adult-onset Still's disease, some porphyrias, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome are diseases in which the ferritin level may be abnormally raised.

According to a study of anorexia nervosa patients, ferritin can be elevated during periods of acute malnourishment, perhaps due to iron going into storage as intravascular volume and thus the number of red blood cells falls.

Another study suggests that due to the catabolic nature of anorexia nervosa, isoferritins may be released. Furthermore, ferritin has significant non-storage roles within the body, such as protection from oxidative damage.

The rise of these isoferritins may contribute to an overall increase in ferritin concentration.

The measurement of ferritin through immunoassay or immunoturbidimeteric methods may also be picking up these isoferritins thus not a true reflection of iron storage status.


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