Elevated Ferritin and Hair Loss: Is there a connection?
A Closer Look at the Causes of Elevated Ferritin
I’ve selected this question below for this week’s question of the week. It allows us to review the concept of elevated ferritin.
Question
I have been diagnosed with male pattern balding. I am a 53 year old male. I have been started on topical 5% finasteride and 0.1 % finasteride. My thyroid function is okay now although it has been known to have thyroid abnormalities last year which we have been monitoring. My ferritin has come back at 563 and my doctor thinks it’s probably due to inflammation. My ANA is negative and my ESR is 10 and CRP is 0.4. I’m pretty health I think. What exactly inflammation would I have? I’m not sure exactly what the doctor is referring to? Where is the source of inflammation?
Thank you for your help and all you do!
Answer
Thanks for the question. This question has a lot of really important points to work through together, so let’s get right to it!
A ferritin of 563 is pretty high so this needs some attention by your medical team - if it has not already. A full history and physical examination are going to be essential here as are some blood tests.
Ferritin is a marker of iron storage in the body and it’s also an acute phase reactant meaning that ferritin levels can go up any time there is inflammation in the body. In other words, ferritin has two roles! It tells us about iron levels in the body and it tells us about inflammation!
Let’s review some of the more common causes of elevated ferritin:
CAUSE 1: Ferritin as a Marker of Acute or Chronic Inflammation
It’s certainly possible your elevated ferritin levels are due to some type of inflammation. There are many inflammatory conditions that can give elevated ferritin but yet be associated with normal ESR and CRP. I would need to review your story with you form head to toe to get a sense of what inflammation there may or may not be.
Inflammation in any organ system can given elevated ferritin and so can a whole host of autoimmune diseases, acute infections. and cancers.
Autoimmune diseases are famous for elevated ferritin. Rheumatoid arthritis. lupus, multiple sclerosis, dermatomyositis can be associated with elevated ferritin. In lupus for example, elevated ferritin levels are associated with disease activity.
CAUSE 2: Ferritin Levels in Infection
Most infections that are serious enough to make a person sick can elevate ferritin levels. For example, sepsis, HIV, TB, CMV, COVID 19, disseminated histoplasmosis and influenza are just some of the many examples. The list is very long though and includes malaria, brucellosis, toxoplasmosis, and leptospirosis among many others.
CAUSE 3: Ferritin Levels in Malignancy
Liquid cancers (blood cancers) and solid tumors can be associated with elevated ferritin. Lymphomas for example often give elevated ferritin. But a range of cancers including hepatocellular carcinoma, colorectal carcinoma, pancreatic cancer and lung cancer can be associated with elevated ferritin. Other blood disorders such as hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) can give extremely high ferritin levels.
CAUSE 4: Elevated Ferritin in Certain Liver Diseases
A variety of liver diseases can elevate ferritin and some also elevate transferrin saturation too. These include excessive alcohol use (generally more than 20 grams or 2 drinks per day), non-alcoholic fatty liver disease and hepatitis.
CAUSE 5: Elevated Ferritin in Obesity and Metabolic Syndrome and Diabetes
Obesity, metabolic syndrome and diabetes can be associated with an elevated ferritin level.
CAUSE 6: Elevated Ferritin in Certain Chronic Diseases
Other conditions including chronic kidney disease, porphyria, hyperthyroidism (especially Grave’s disease), anemias, are all be associated with elevated ferritin.
CAUSE 7: Elevated Ferritin in Hemochromatosis and Iron Overload States
Hemochromatosis is one of the important genetic conditions associated with elevated ferritin. This is a condition that affected about 1 in 200 people of European ancestry. Patients with hemochromatosis inherit a gene from their mother and a gene from their father that increases the ability of their digestive system to absorb iron. The first step in the diagnosis of hemochromatosis is to confirm that the patient has an elevated transferrin saturation and and elevated ferritin. Generally speaking, a transferrin saturation above 0.45 and a ferritin above 300 in men and 200 in women should prompt one to pursue further work up for hemochromatosis. You might want to review an article I wrote in the past on hemochromatosis.
Other conditions like chronic blood transfusions and blood disorders that chronically destroy red blood cells (thalassemias, hemolytic anemias, sideroblastic anemia) can give elevated ferritin.
Elevated ferritin together with elevated transferrin saturation is seen in porphyria cutanea tarda (normal HGB), Sideroblastic anemia (low HGB), Thalassemia (low HGB), B12 deficiency (low HGB)
Summary
I don’t know why you have an elevated ferritin as I don’t have enough information from you. Certainly, it would be important for you to sit down with your doctor and review all the causes of elevated ferritin and have a full physical examination. There are just so many causes including infections, cancer, autoimmune diseases, liver disease, metabolic syndrome, alcohol intake, transfusions, blood disorders and hemochromatosis
You are probably going to want to have some blood tests and I’m sure some of these you’ve already had done. Anyone with elevated ferritin should consider having some basic tests such as serum iron, TIBC (to calculate transferrin saturation), CBC, ESR, CRP, AST, ALT, creatinine, TSH, ANA, glucose, hemoglobin A1c, cholesterol. Consideration can be given to having a serum protein electrophoresis (SPEP, anti HCV, HbSAg, HBSAb, RPR, HIV, RF, anti-CCP, CK , serum copper, ceruloplasmin, alpha 1 antitypsin and anti-SMA but these are generally ordered on a case by case basis depending on the findings of the history and physical examination. Acutely ill patients with elevated ferritin may require additional testing as well which would not apply to a stable otherwise healthy patient.
I hope this helps and thanks for the great question.