Ferritin: what is it, how to prepare for analysis

Ferritin: what is it?

Ferritin is a complex complex of proteins that plays the role of a battery of iron molecules. From the Latin name of the chemical element iron (ferrum, Fe) comes the name of the iron-containing protein complex - ferritin. It is ferritin that supplies iron to every cell that needs it.

The human body does not synthesize iron itself. This element comes to us with food. The level of iron absorbed directly depends on age. The younger a person is, the higher his ability to isolate this element from food and store it in the form of ferritin. Children in the first year of life can absorb the maximum amount of iron – up to 70% of the amount consumed. By the age of 10 years, the body shaves 7 times less of the incoming volume. Adults receive only 10% of the iron they eat per day.

The chemical processes of a healthy person’s body clearly control the amount of iron in the blood and, if necessary, adjust the distribution of the resulting volume of elements. For example, with a sufficient amount of iron in the body, the absorbed part of it can be set aside as a kind of preparation “for a rainy day” - this is ferritin, which, when the first need arises, will deliver iron in the required volume to the organ in need. And with a reduced concentration of iron in the body, ferritin does not replenish its reserves, since the entire absorbed volume is immediately distributed throughout the tissues.

Ferritin is located in the liver, plasma, bone marrow, placenta and spleen. The level of total ferritin in the body is determined by studying the composition of blood plasma.

Still have questions? Contact us:

What happens when there is low acidity in the stomach?

Low acidity in the stomach leads to poor protein breakdown. Trivalent iron does not convert into divalent iron, and, entering the intestines unchanged, is poorly absorbed. Low acidity reduces the production of intrinsic factor in the stomach. This is a protein that converts vitamin B12 into an absorbable form and transports it to the intestines. With low acidity, vitamin B9 (folic acid) is almost completely destroyed, and it is necessary for the synthesis of amino acids and the absorption of vitamin B12.

What affects the production of hydrochloric acid?

The key stimulators of the production of gastric juice - hydrochloric acid - are histamine, acetylcholine and gastrin. Gastrin has the greatest effect. It is produced by endocrines - G-cells. The production of gastrin depends on somatostatin, a hormone produced by the pancreas and hypothalamus. Somatostatin suppresses gastrin production. The secretion of digestive enzymes and bile is disrupted, and acidity decreases.

The function of the hypothalamus is closely related to the function of the thyroid gland and pituitary gland. If there is a violation, protein from food will not be absorbed.

Integrated approach: ferritin, hormones, iron, folic acid, TSH

For effective treatment, in addition to ferritin levels, it is necessary to check hormonal levels, serum iron levels, vitamins B12 and B9 (folic acid). If the level of iron and vitamins B12 and B9 is low, protein supplements alone will not be able to increase ferritin levels. The problem must be solved as a whole. It is worth noting that the levels of copper, calcium, and vitamin C do not play

Ferritin: normal levels

Various diseases or certain physiological processes can affect ferritin levels. Natural reasons for decreased performance include:

periodic female bleeding;
pregnancy;
dieting.

To monitor health status as a preventive measure, as well as in case of symptoms typical of iron deficiency, a biochemical blood test for ferritin is performed. The collected biomaterial is examined to understand how many micrograms of iron are contained in one liter of plasma.

The norms for each age group are different:

in newborns from 25 to 600 mcg/l;
in children older than 28 days, but not yet 9 weeks of age, the norm is 20-600 mcg/l;
in children from 2 to 5 months it should be from 50 to 200 mcg/l;
children aged from six months to one year should have from 70 to 140 mcg/l;
girls and women over 12 years of age should have a normal level of 22 to 180 mcg/l;
boys and men over 12 years old - from 30 to 310 mcg/l.

Women's blood contains less ferritin because it contains less hemoglobin, red blood cells and iron molecules. In addition, pregnancy makes its own adjustments to ferritin levels:

in the first trimester of pregnancy, levels can reach 90 mcg/l;
in the second trimester, blood contains up to 74 mcg/l;
and the third trimester is famous for its low ferritin level - only 10-15 mcg/l.

Low ferritin levels. Good hemoglobin is not yet an indicator

Do you get tired out of the blue? Your body may not have enough iron. Doctors say that many Belarusians experience iron deficiency, but they don’t even know about it.

“There are concepts of iron deficiency anemia and latent iron deficiency,” Tatyana Rachkova, head of the consulting department of the Minsk Clinical Consulting and Diagnostic Center, told a 1prof.by correspondent. – Anemia is indicated by a low hemoglobin level, but a latent state is when the hemoglobin level is still normal, but iron reserves are already depleted. One hundred percent confirmation of this condition is low ferritin levels. The development of iron deficiency can be caused by diseases of the gastrointestinal tract, and in women - by gynecological problems. As practice shows, 30% of Belarusian women of reproductive age suffer from a latent form of iron deficiency; iron deficiency anemia occurs in 10%. This is a fairly large percentage, considering that I do not take into account pregnant and lactating women.

– What symptoms should make a person check their blood for ferritin and why are we talking about it?

– The ferritin level always reflects the real picture of things, while serum iron is a rather subjective indicator, it can change for various reasons. As for symptoms, it’s better not to wait for them: each of us should take a routine blood test at least once a year. It is necessary to perform a general blood test and ferritin level out of hours if you begin to feel uncharacteristic weakness during normal physical activity. Other common symptoms include: shortness of breath, a feeling of lack of air in a poorly ventilated room (although previously you could tolerate such an environment quite calmly), lightheadedness, brittle and depleted nails, hair loss, perversion of taste: people want to eat dry buckwheat or chalk.

To determine the cause of iron deficiency, it is necessary to undergo available examinations. Women, first of all, should be examined by a gynecologist, since even heavy menstruation can gradually deplete iron reserves. The second step is to, as people say, “swallow the probe.” The fact is that a biopsy performed during this procedure will help determine the problem that impairs the absorption ability of the stomach. If it is reduced, then, of course, a person will lack many useful substances, including iron.

– It turns out that anemia can occur in people who eat according to the principle “I eat meat with meat”?

– Certainly. If the absorption capacity of the gastrointestinal tract changes, no matter how much beef or offal we eat, the body will receive less than it needs.

– Let’s say the root cause has been eliminated. Can you replenish your iron supply with food alone?

– No anemia can be treated solely by diet, since there is not enough iron in foods for a therapeutic effect. This requires taking special medications. When taken orally (tablets), there will be no overdose: the body will remove the excess itself. An excess of iron, which is also dangerous to health, can be caused by intramuscular and intravenous injections. Therefore, you cannot self-medicate; injections must be given strictly as prescribed and under the supervision of a doctor.

– Are there any features of the development of iron deficiency in children?

- Eat. For example, babies whose mothers experienced a lack of the element during pregnancy are at risk. It should also be taken into account that children in the first year of life grow very quickly and they require more iron than adults. This is why pediatricians recommend introducing complementary foods from the age of six months: oddly enough, breast milk today contains less iron than special milk formulas. Deficiency can also be caused by frequent infectious diseases (they require greater iron intake). That is, if the child is healthy and is on an adequate, balanced diet, then, most likely, he will not face iron deficiency conditions. But in any case, a blood test once a year is mandatory for children too.

– You mentioned “adequate” nutrition. Is vegetarianism a risk factor or is it the norm?

- I’ll answer this way. Iron is absorbed more intensively by our body in its divalent (heme) form. Animal products contain just such iron, as well as essential amino acids and protein necessary for the iron to be built exactly where it is needed. Plant foods contain only ferric iron, which means it is absorbed much less well. If a vegetarian also has some related health problems, we will definitely come up with iron deficiency. I cannot dictate a person’s diet. But as a doctor, I am obliged to warn about this development of events. It is clear that there is no need to abuse protein, but completely abandoning it is also bad. Constantly replenishing iron through synthetic drugs is not an option. Iron in the form of tablets and vitamins is in some sense foreign to the body. Essentially, it is an aggressive chemical element that can cause micro-erosions when absorbed. It’s one thing when it is prescribed for medicinal purposes, and quite another when a person himself decides to abuse the body by replacing food with a drug.

– Now doctors often prescribe a general blood test with a detailed leukocyte formula. What it is?

– The general analysis includes only indicators of hemoglobin, platelets, leukocytes and erythrocytes. And they can be quite normal thanks to the adaptive capabilities of the body. And in the leukocyte formula, the percentage of different types of leukocytes is determined, which makes it possible to suspect even the prerequisites for some problem or a disease in the initial stage. Therefore, I insist on precisely this detailed analysis.

– We talked to you about low hemoglobin. What does the increased rate indicate?

- About the fact that you need to pay attention to yourself. Many rejoice, seeing a very high level in the analyzes and in vain. This condition is called symptomatic erythrocytosis. First of all, smokers (due to a constant lack of oxygen in the tissues) and people with high blood pressure are susceptible to it. In addition, high hemoglobin carries a risk of dangerous thrombotic situations. Therefore, even with a high hemoglobin level, it is necessary to consult a specialist.

It is also necessary to mention such an important indicator as platelets; I note that previously this indicator was not included in a routine blood test. Now such studies are mandatory. And this is very good. For example, a low platelet level (above 50 thousand) does not manifest itself in any way in everyday life. But this is the first indicator of the risk of bleeding, which can only reveal itself with surgery. Therefore, I repeat once again: do not neglect preventive tests and take care of yourself.

Interviewed by Elena ORLOVA

Why is low ferritin dangerous?

A decrease in ferritin levels is primarily an indication for analysis of the nutritional system. Most often, insufficient iron levels in the blood are caused by improper diets or fasting. The second most popular cause is bleeding and diseases of the digestive system. With blood loss, large volumes of iron leave the body, and due to impaired absorption function, the deficiency cannot be replenished.

With a lack of ferritin, the following symptoms appear:

brittle nails;
hair loss;
decreased libido;
mood swings;
increased heart rate;
dizziness;
memory impairment.

Low ferritin, if not detected in time, and nutrition adjustments and the necessary treatment are not started, can become an impetus for the development of iron deficiency anemia.

Diagnosis of iron deficiency

Currently, several laboratory tests have been developed to diagnose iron deficiency. The main ones include determining the following blood parameters:

the amount of serum iron;
indicator of total iron-binding capacity of serum (TIBC);
transferrin iron saturation percentage;
ferritin amount;
amount of hemoglobin.

It is important to understand that it is a big mistake to prescribe iron supplements solely based on the results of determining low ferritin. In the presence of a MTHFR mutation that disrupts the processing and absorption of iron, folic acid, and vitamin B12, ferritin is always low and serum iron is high, which does not allow prescribing iron supplements to such patients.

The goals of laboratory tests for iron deficiency anemia are:

identification of disturbances in iron metabolism;
determination of the nature of anemia;
assessing the risk of developing iron overload in the body.

Preparation for laboratory tests for anemia is simple and fairly standard. It is necessary to donate blood in the morning, strictly on an empty stomach (with an 8-hour break after eating). The day before testing, you must stop taking iron supplements and/or multivitamins. If radioisotope diagnostics were carried out the day before, the study of iron metabolism should begin no earlier than 4-5 days after its completion. It is also important to consider that some medications may interfere with test results. For example, estrogen or oral contraceptives can increase TBI, while corticosteroids and testosterone, on the contrary, lower TBI.

High ferritin levels

High ferritin, close to the normal limit, indicates that tissues and organs receive a sufficient amount of iron every day from the diet, thanks to which the body is able to store reserves of an important element. If the values obtained as a result of laboratory tests gave inflated indicators, significantly beyond the acceptable limits, this is a reason to examine to identify:

oncology;
infection with the immunodeficiency virus;
problems in the functioning of the endocrine system.

Separately, you need to analyze your diet. Perhaps excess iron can easily be explained by a diet rich in this element.

Clinical manifestations and symptoms

The main symptoms and complaints of iron deficiency anemia are:

excessive fatigue and decreased ability to perform strenuous physical activity;
headache;
muscle cramps of the lower extremities;
desire to chew ice or chalk;
decreased learning ability;
reduced resistance to infectious diseases;
shortness of breath, chest pain;
dysphagia;
pallor of mucous membranes;
koilonychia;
atrophy of the tongue papillae;
angular stomatitis.

Although the diagnosis of iron deficiency anemia is based on the results of laboratory examination, a carefully collected clinical history can greatly facilitate the early detection of this condition, help confirm the etiology of anemia, and also assess the duration of its existence. Iron deficiency anemia develops gradually, and patients most often remain asymptomatic until the body's iron stores are completely depleted, which will lead to disruption of red blood cell synthesis, the functioning of other cells, and, as a result, fatigue and other symptoms.

Half of patients with moderate iron deficiency anemia have pagophagia. Usually the main manifestation of this condition is the desire of patients to live or suck ice, as well as frozen vegetables. Muscle cramps that occur when climbing stairs are also a common early manifestation of iron deficiency anemia. Most often, patients can accurately name the date when these symptoms appeared, which makes it possible to estimate how long the patient has been in a state of iron deficiency.

Fatigue and decreased tolerance to heavy physical activity in iron deficiency anemia are associated with a decrease in the amount of hemoglobin in red blood cells. However, the severity of these symptoms often does not correlate with the level of anemia, which may be due to disruption of other proteins in which iron is a major coenzyme or structural component. A large amount of new evidence supports the idea that iron deficiency leads to deficiency and dysfunction not only of hemoglobin, but also of other enzymes and structural proteins, which leads to the development of muscle dysfunction, pagophagia, dysphagia, decreased mental abilities, weakened immune response to infectious agents and changes in behavior .

Two-thirds of the iron in the body is contained in the hemoglobin of red blood cells. Each gram of hemoglobin contains 3.47 mg of iron. Thus, the loss of a milliliter of blood results in the loss of 0.5 mg of iron. Chronic blood loss associated with parasitic infestations, cancer and other conditions is the most common cause of iron deficiency. Bleeding from the gastrointestinal tract is difficult to notice, and often patients do not understand the significance of tarry stools (melena). Also, excessive menstrual blood loss is often not voiced by patients as a complaint, only in case of cycle disruption. In this case, the presence of clots, pain in the lower abdomen, and the use of several tampons or pads may lead the doctor to think about possible menometrorrhagia.

With anemia, nonspecific pallor of the mucous membranes is observed. Iron deficiency anemia is also characterized by changes in epithelial structures: damage to the esophageal mucosa, koilonychia, glossitis, angular stomatitis and atrophic gastritis. The exact relationship between these conditions and iron deficiency is still unclear. It is assumed that these conditions may be caused by other associated factors. Thus, it was shown that 15% of patients with iron deficiency anemia from European countries experience the previously listed symptoms. At the same time, in patients from the USA, these manifestations of iron deficiency anemia were extremely rare.

Splenomegaly can develop in cases of severe persistent iron deficiency anemia without treatment.