EXTREMELY ELEVATED SERUM FERRITIN LEVELS IN A UNIVERSITY HOSPITAL - ASSOCIATED DISEASES AND CLINICAL-SIGNIFICANCE

PURPOSE: TO establish the frequency with which serum ferritin levels greater than or equal to 1,000 ng/mL occur in a general hospital population, and to determine the clinical significance of this finding. PATIENTS AND METHODS: All serum ferritin determinations performed between June 1992 and July 1993 at the University of Cincinnati Medical Center were reviewed and patients with serum ferritin levels greater than or equal to 1,000 ng/mL identified. The medical records of these patients were then reviewed. RESULTS: Of 1,826 serum ferritin determinations performed during the study period, 122 (6.7%) were greater than or equal to 1,000 ng/mL. Associated clinical syndromes found in the 95 patients with serum ferritin greater than or equal to 1,000 ng/mL included liver disease (20.0%), renal disease (17.9%), malignant disease (17.9%), human immunodeficiency virus (HIV) infection (16.8%), non-HIV systemic infections (15.8%), chronic transfusions (10.5%), and sickle cell syndromes (10.5%). No syndrome usually associated with extreme serum ferritin elevations was identified in 8.4% of patients, and 16.8% of the patients fell into more than one category. The highest mean serum ferritin levels occurred in the chronically transfused and sickle cell groups. Concomitant serum transferrin saturation values were determined with 82 (86.3%) of the elevated serum ferritin levels and did not correlate well with them. The highest mean transferrin saturation levels occurred in the liver disease group. Transferrin saturation greater than or equal to 50%, suggestive of iron overload, was significantly more frequent in the liver disease group (P = 0.002); and saturation less than or equal to 15%, suggestive of iron-deficient: erythropoiesis, was significantly more frequent in the HIV group (P = 0.001). CONCLUSION: Outside the setting of clinical syndromes associated with iron overload (liver disease, transfusions, sickle cell syndromes), serum ferritin levels greater than or equal to 1,000 ng/mL serve as a nonspecific marker for a variety of significant