Causes of Elevated Serum Ferritin

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Ferritin is a protein that plays a key role in iron metabolism by binding and storing excess iron within cells. According to "Harrison's Principles of Internal Medicine," serum ferritin levels correlate with total body iron stores. Normal ferritin values average 100 mcg/L for adult males and 30 mcg/L for adult females. A number of conditions cause high serum ferritin levels with or without iron overload.

Iron Overload

Hereditary hemochromatosis, the most common cause of iron overload, is also called "bronze diabetes" because a patient's skin may be slate-colored, and diabetes occurs in approximately 65 percent of patients. Enlargement of the liver occurs in more than 95 percent of patients. Serum ferritin greater than 1,000 mcg/L indicates the need for a liver biopsy to check for cirrhosis.

Treatment involves removing 400 to 500 mL of blood per week to keep ferritin at approximately 50 mcg/L.

Inflammatory Conditions

Systemic lupus erythematosis, a disease characterized by inflammation that may affect most organs, commonly has high serum ferritin levels during disease flare-ups. Rheumatoid arthritis and Epstein-Barr may also cause elevated serum ferritin.


Regular consumption of alcohol disrupts iron metabolism: one-third of alcoholics have excess iron deposited in their livers, and according to "Harrison's Principles of Internal Medicine," serum ferritin can rise to 500 mcg/L in these patients. Serum ferritin decreases with abstinence from alcohol.


Acute viral hepatitis A, B, C cause elevated serum ferritin due to liver inflammation. Hepatitis C causes damage by binding iron, resulting in free radicals that damage liver cells. The liver becomes inflamed, leading to formation of scar tissue and ultimately cirrhosis or liver cancer.

According to Life Extension, approximately 30 percent of people with hepatitis C have very high iron levels. Reduction of serum iron has been shown to normalize liver enzyme levels, which are elevated during periods of active liver damage.