High Ferritin
Ferritin is the protein that stores iron. A high level can mean too much iron, but far more often it’s a sign of inflammation, alcohol or a fatty liver. Your doctor works out which with a couple of simple follow-up tests.
Quick answer: A ferritin above about 200 µg/L in women or 300 µg/L in men is high. About 9 in 10 high results come from fatty liver, alcohol, inflammation or infection, not iron overload. A fasting transferrin saturation over 45% points to haemochromatosis. Ferritin over 1000 µg/L needs specialist review.
What the test measures
Ferritin stores iron inside your cells, and a little leaks into the blood, so the blood level mirrors your iron stores. But ferritin is also an acute-phase protein: it rises with inflammation, infection, liver damage and alcohol whether or not you have extra iron. That’s why a high ferritin on its own doesn’t prove iron overload.
Typical adult ranges
- Women: about 30–200 µg/L
- Men: about 30–300 µg/L
- µg/L is the same number as ng/mL, the unit used in the US.
- There is no single standard range, and some labs use a lower limit of 15–20 µg/L. Use the range on your report.
What a high result usually means
Common causes (about 90% of high results):
- Fatty liver and metabolic syndrome: carrying extra weight around the middle, type 2 diabetes or prediabetes, high triglycerides. See fatty liver.
- Alcohol, even regular moderate drinking.
- Inflammation or infection: a recent virus, a flare of arthritis, inflammatory bowel disease.
- Liver disease such as hepatitis B or C.
- Iron tablets or an iron infusion in the last few weeks or months.
- Kidney disease and some cancers.
Less common but important:
- Haemochromatosis: an inherited tendency to absorb too much iron. About 1 in 200 people of northern European ancestry carry the high-risk gene pair (two copies of C282Y), though not all of them build up harmful amounts of iron.
- Iron overload from repeated blood transfusions, for example in thalassaemia.
- Blood disorders that break down red cells or make them poorly.
- Extremely high ferritin, often in the tens of thousands, in someone who is very unwell with fever: rare conditions such as haemophagocytic lymphohistiocytosis (HLH) or adult-onset Still’s disease. These are hospital problems, not GP-letter problems.
Symptoms
High ferritin itself causes no symptoms. The cause might: tiredness, joint pain (classically the knuckles of the index and middle fingers in haemochromatosis), low libido or erectile problems, and abnormal liver tests. Many people with early haemochromatosis feel completely well.
What happens next
- Repeat iron studies, ideally fasting and in the morning, including transferrin saturation (how full your iron transport protein is). Repeat once you’ve recovered from any recent illness.
- Transferrin saturation over 45% suggests iron overload, and your GP will usually order an HFE gene test. A normal transferrin saturation makes haemochromatosis very unlikely.
- Liver tests, CRP, glucose and lipids, and often a liver ultrasound if fatty liver is likely.
- Treat the cause. Weight loss and less alcohol often bring ferritin down over months. Stop iron supplements unless you’ve been told to take them.
- Haemochromatosis is treated by regularly removing blood (venesection). In Australia, Lifeblood can collect this blood from many people with haemochromatosis.
- Referral to a gastroenterologist, hepatologist or haematologist if ferritin is over 1000 µg/L, liver tests are abnormal, or the cause isn’t clear.
See your GP within a week or two if your ferritin is over 1000 µg/L: specialist review is advised because of the risk of liver scarring. See a doctor the same day for yellow skin or eyes, a swollen tummy, vomiting blood or confusion. Get urgent help (000 in Australia, or your local emergency number) if someone is very unwell with a high fever and has been told their ferritin is in the thousands.
Practise reading results. Play Panelysis, the daily blood-test puzzle: a fictional patient, a real-looking panel, three guesses. More in medical games.
Common questions
Is a ferritin of 500 dangerous?
Usually not on its own. Most ferritin results between 300 and 1000 µg/L come from fatty liver, alcohol or inflammation rather than iron overload, and below 1000 µg/L the risk of iron damaging your liver is very low unless you have haemochromatosis. Your doctor will check transferrin saturation and liver tests to find the cause.
What ferritin level is too high?
Above about 200 µg/L in women or 300 µg/L in men is above the usual range. Over 1000 µg/L calls for specialist review because the risk of liver scarring rises. Extremely high levels, in the tens of thousands, are rare and usually found in people who are already very unwell.
Does high ferritin mean I have haemochromatosis?
Probably not. Only about 1 in 10 high ferritin results is due to iron overload. A transferrin saturation over 45% raises the possibility, and a gene test confirms it. A normal transferrin saturation makes haemochromatosis very unlikely.
Can alcohol raise ferritin?
Yes. Regular drinking is one of the commonest causes of a high ferritin, even without liver disease. Cutting back often brings it down over a few months, and your doctor may simply repeat the test.
Can an infection or a cold raise ferritin?
Yes. Ferritin rises with infection and inflammation, so a result taken during or soon after an illness can be falsely high. Many doctors repeat the test a few weeks after you’ve recovered.
Should I stop my iron tablets if my ferritin is high?
Usually yes, unless a doctor has told you to keep taking them, for example after an infusion plan for a specific reason. Check multivitamins too, since many contain iron. Talk to your GP before stopping anything prescribed.
Evidence and more information
- Pathology Tests Explained (RCPA): Ferritin (ranges and what affects the result)
- Pathology Tests Explained (RCPA): Iron studies
- Australian Family Physician 2012: Elevated serum ferritin, what should GPs know? (causes, transferrin saturation, the 1000 µg/L threshold)
- Cullis et al, British Journal of Haematology 2018: BSH guideline on investigating a raised serum ferritin
- Norfolk and Norwich University Hospitals NHS: Investigating a raised ferritin result (GP guidance)
maladywise.com/blood-tests/high-ferritin/