Ferritin

Doctors from different countries note that patients with COVID-associated pneumonia are diagnosed with high levels of ferritin, which can reach 600 μg/L or higher. At the same time, there is a tendency to a slight decrease in indicators throughout the treatment period. Medvestnik asked the head of the Department of Clinical Hematology and Transfusiology of BelMAPO, Professor Lyudmila Smirnova, what a clinician needs to know about ferritin as a marker of the acute phase of inflammation.

Lyudmila Smirnova, Professor, Head of the Department of Clinical Hematology and Transfusiology BelMAPOWhat kind of protein is this?

Ferritin is synthesized by cells of various organs and tissues, primarily the liver, spleen, bone marrow, heart muscle, lungs, kidneys, thyroid gland, placenta, small intestine, pancreas, as well as leukocytes. Molecular weight 440 kDa. Ferritin accumulates and stores iron in the body in a non-toxic and bioavailable form.

It is localized predominantly intracellularly, but a small (strictly defined) amount of it is present in the blood plasma, which is determined in the laboratory as the “ferritin” indicator. The norm for women is 20–150 mcg/l (ng/ml), for men 40–300 mcg/l (ng/ml). Ferritin receptors are present on the membranes of normal and pathological cells. Secreted ferritin performs the following functions: regulation of myelopoiesis, lymphocyte migration, immunosuppressive function.

Marker of anemia and hyperferritinemia

The “serum ferritin” indicator is traditionally used as a marker of iron deficiency or excess in the body, as well as in monitoring the treatment of iron deficiency conditions. A serum ferritin level of less than 40 mcg/L is regarded as iron deficiency and indicates the presence of iron deficiency anemia. A serum ferritin level of more than 300 mcg/l (for men and women) is regarded as hyperferritinemia, which may be due to iron overload in the body (with prolonged frequent transfusions of red blood cells, hemochromatosis), as well as a sign of inflammation or tumor.

The correspondence between the level of serum ferritin (SF) and iron reserves in the body is lost during inflammatory processes, liver diseases, and tumors. In these cases, serum ferritin increases regardless of iron stores. An increase in ferritin levels is observed in COVID-associated pneumonia.

Connection with oncological processes

Ferritin can be regarded as a nonspecific cancer marker. With rapidly proliferating tumors, an increase in this indicator is observed. This hyperferritinemia does not reflect the metabolic processes of iron and its amount in the body.

Ferritin is also associated with increased apoptosis during anticancer therapy. The experiment showed that divalent metals, primarily iron, can be modifiers of apoptosis. This mechanism of hyperferritinemia is also possible during an infectious process before or during the period of convalescence.

It has been established that malignant tumors and chronic inflammation lead to a reduction in the transport (transferrin) pool of iron. In the presence of inflammation (tumor), low levels of iron in the serum are characteristic (the “serum iron” indicator drops), the concentration of transferrin is reduced with a high level of ferritin. Transferrin is a “negative” protein of the acute phase of inflammation, its level in plasma decreases.

Indicator of the acute phase of inflammation

An increase in ferritin levels is observed during acute inflammation, since ferritin acts as an acute-phase protein. During acute inflammation, the C-reactive protein (CRP) level increases significantly, but then usually its level decreases before the ferritin level, giving the so-called scissors: the ferritin level increases, and the CRP level decreases.

During treatment with positive dynamics, the CRP level decreases, the ferritin level may remain at the same high values ​​or even increase. This is most likely due to the fact that CRP is synthesized mainly in the liver, and ferritin, in addition to the liver, is synthesized in the lungs and myocardium. As a result, in case of pneumonia or myocardial damage, ferritin will remain high.

Ferritin is associated with tumor necrosis factor alpha (TNF-α), which is released by certain cells as a result of exposure to a variety of stimuli: viruses, ultraviolet radiation, interleukins (including IL-6), and oxidative stress. These facts suggest that, due to its unique biochemical properties, ferritin is at the center of several regulatory mechanisms involved in a wide range of metabolic processes during inflammation.

For example, the level of ferritin increases during the period of infection with the human immunodeficiency virus; it is this period that corresponds to maximum lymphoid activation (the number of T-helper cells increases), and lymphadenopathy is characteristic.

Against the background of an acute infectious process, so-called anemia of a chronic disease (D-63 according to ICD-10) can develop, including anemia of inflammation. This type of anemia is characterized by a decrease in serum iron against the background of increased ferritin. In a general blood test, such anemia is characterized by low MCV and MCH values, that is, it is microcytic and hypochromic. Reminds me of iron deficiency anemia. Iron supplements should not be prescribed, since this is anemia of a chronic disease, characterized by normal and even increased iron reserves in macrophages, against the background of high levels of pro-inflammatory cytokines (IL-6, TNF-α, etc.). After relief of pneumonia, anemia of moderate severity (more than 70 g/l) may persist for some time, this indicates that the inflammation process is not completed (ferritin is high, CRP is slightly increased). The hemoglobin level normalizes with complete relief of inflammation.

Transfusions of erythrocyte-containing media are indicated when hemoglobin levels are less than 70 g/l. However, it is necessary to take into account not only the hemoglobin level, but also the general condition of the patient, hemodynamic changes caused by the individual response to anemic hypoxia.

Growth in multiple organ failure

The reason for the increase in serum ferritin in various types of liver pathology (severe hepatitis, cancer, cirrhosis) is associated with the process of ferritin release from hepatocytes during their destruction. In liver pathology, ferritin levels also increase against the background of a parallel increase in the levels of AST and ALT. In case of multiple organ failure, one should expect very high levels of ferritin due to its release from hepatocytes, myocardial tissue, and lungs.

Summary

Thus, during the inflammatory process, including COVID-associated pneumonia, the ferritin level rises to more than 300 µg/l, sometimes reaching a level of more than 1,000 µg/l; transferrin decreases (less than 2 g/l), serum iron is below normal (less than 11 µmol/l). The CRP level increases significantly, in parallel or ahead of the ferritin level for several days.

The fibrinogen level increases by more than 4 g/l, reaching values ​​of more than 10 g/l.

During treatment with positive dynamics: the CRP level decreases, the ferritin level may remain at the same high values ​​or even increase slightly. With pneumonia or myocardial damage, ferritin will remain high, and with liver pathology, an increase in ferritin is combined with increased levels of AST and ALT.

Upon recovery, all markers of the acute phase of inflammation return to normal values.

The use of several inflammatory markers allows for more adequate and complete monitoring of the pathological process.

Ferritin

Ferritin is a protein in which iron is stored in tissues.

Synonyms Russian

Deposited iron, metalloprotein, indicator of iron reserves.

English synonyms

Ferritin.

Research method

Immunoturbidimetry.

Units

μg/L (micrograms per liter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

• Do not eat for 8 hours before the test; you can drink clean still water.
• Stop taking medications containing iron 72 hours before the test.
• Avoid physical and emotional stress and do not smoke for 30 minutes before the test.

General information about the study

Ferritin is a protein in the form in which iron is mainly stored in the body.

It is absorbed from food and then transferred by transferrin, a special protein that is formed in the liver. Iron is necessary for the formation of red blood cells and is an essential part of hemoglobin, a protein that fills red blood cells and allows them to carry oxygen from the lungs to organs and tissues. In addition, it is part of the muscle protein myoglobin and some enzymes.

Normally, the body contains 4-5 grams of iron. About 70% of this amount is iron, “built-in” into the hemoglobin of red blood cells. The remainder is mainly stored in tissues as part of protein complexes - ferritin and hemosiderin - which are mainly found in the liver, as well as in the bone marrow, spleen and muscles. Although ferritin is present in small amounts in the blood, its concentration reflects the body's iron stores.

When iron begins to be scarce, for example, in the case of reduced intake of it with food or frequent bleeding, the body begins to use reserves from tissues. The amount of ferritin decreases accordingly. A long-term lack of iron intake can lead to anemia. Ferritin levels can be reduced long before the symptoms of iron deficiency appear and allow anemia to be diagnosed in time.

On the other hand, if too much iron is taken in, it can lead to excessive iron accumulation and, as a result, damage to the liver, heart and pancreas.

It is worth noting that the use of various tests that reflect iron metabolism in the body provides more complete and reliable information about the deficiency or excess of this microelement than just a ferritin test.

What is the research used for?

• To assess iron reserves in the body. This is necessary to identify iron deficiency or excess.
• To determine whether anemia is caused by a lack of iron or other causes, such as a chronic illness or lack of vitamin B12.

When is the study scheduled?

• If abnormalities are detected in tests such as general blood count, hemoglobin, hematocrit, red blood cell count.
• If you suspect a deficiency or excess of iron in the body.

In the early stages, iron deficiency may be asymptomatic. If a person is otherwise healthy, then signs of the disease sometimes appear only when hemoglobin drops below 100 g/l. The development of anemia is indicated by the following complaints: chronic weakness/fatigue, dizziness, headaches.

With severe anemia, the patient may suffer from shortness of breath, chest pain, severe headaches, and weakness in the legs. Children have learning difficulties.

In addition to the main ones, there are several more signs characteristic of iron deficiency: the desire to eat unusual foods (chalk, clay), burning of the tip of the tongue, jams - cracks in the corners of the mouth.

• If you suspect iron overload (hemochromatosis). This condition can manifest itself in different ways, for example, pain in the joints, abdominal pain, weakness, fatigue, decreased sexual desire, and irregular heart rhythm.
• When monitoring the effectiveness of treatment of anemia and conditions accompanied by iron overload.

What do the results mean?

Reference values

Reasons for low ferritin levels

• Iron deficiency, including hidden. A decrease in ferritin below 10 ng/ml usually indicates iron deficiency anemia.
• Third trimester of pregnancy. A decrease in the amount of iron in this case is normal.

Causes of increased ferritin levels

• Hereditary hemochromatosis. In this disease, too much iron is absorbed from food and deposited in various organs, causing them to become damaged.
• Multiple blood transfusions, intramuscular iron administration, administration of iron tablets.
• Inflammations, such as upper respiratory tract infections, urinary tract infections, autoimmune diseases. Moreover, an increase in ferritin in the acute phase of inflammation can mask the existing iron deficiency.
• Acute or chronic liver diseases.
• Alcoholism.
• Hemolytic anemia: associated with the destruction of red blood cells, B12 deficiency anemia, thalassemia.
• Hyperthyroidism – increased function of the thyroid gland.
• Oncological diseases of the bone marrow, breast cancer, Hodgkin's disease - a malignant neoplasm of lymphoid tissue. Ferritin levels will increase significantly.

What can influence the result?

• Falsely increased results can be caused by: fasting,
• alcohol, estrogens, oral contraceptives, iron supplements.


Important Notes

• The body normally loses iron through the desquamation of skin cells, as well as through feces and sweat. To replenish these losses, at least 1 mg of iron per day is required from food, twice as much for women during menstruation. A normal balanced diet provides 10-15 mg of iron per day, about 10% of this amount is absorbed. The main sources of iron in food: meat, fish, greens and cereals.
• Ferritin levels remain normal if iron deficiency is accompanied by inflammation. Therefore, to identify iron deficiency in such a situation, the joint administration of tests for ferritin and transferrin can be used.

Also recommended

• Serum iron
• Iron binding capacity of serum
• Latent iron binding capacity of serum
• Transferrin
• Hemoglobin
• Hematocrit
• Red blood cells

Who orders the study?

General practitioner, therapist, hematologist, gastroenterologist, rheumatologist, nephrologist, surgeon.

RESULTS:

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POLICY OF INDIVIDUAL ENTREPRENEUR VLADIMIR YURIEVICH BIRYUKOV IN REGARD TO THE PROCESSING AND PROTECTION OF PERSONAL DATA (PRIVACY POLICY)

1. GENERAL PROVISIONS 1.1. This Policy is carried out by individual entrepreneur Vladimir Yuryevich Biryukov (hereinafter referred to as the “Company”) in relation to the processing and protection of personal data (hereinafter referred to as the “Policy”) of individuals (personal data subjects) on the basis of Article 24 of the Constitution of the Russian Federation, Chapter 14 of the Labor Code of the Russian Federation, Federal Law of July 27, 2006 N 152-FZ (as amended on July 25, 2011) “On Personal Data”, other regulations of the Russian Federation.

1.2. The Policy applies to all personal data (subjects) that may be obtained by the Company in the course of its activities, including employees and clients of the Company.

1.3. The purpose of the Policy is to provide persons providing their personal data with the necessary information that allows them to assess what personal data and for what purposes are processed by the Company, and what methods are implemented to ensure their security.

1.4. The policy was developed to ensure the protection of the rights and freedoms of personal data subjects when processing their personal data, as well as to establish the responsibility of Company officials who have access to the personal data of personal data subjects for failure to comply with the requirements and standards governing the processing of personal data.

1.5. Clients, using the Company’s services and providing the Company with their personal data, including through the mediation of third parties, acknowledge their consent to the processing of personal data in accordance with this Policy.

1.6. Consent to the processing of personal data may be withdrawn by the subject of personal data. If the subject of personal data withdraws consent to the processing of personal data, the Company has the right to continue processing personal data without the consent of the subject of personal data if there are grounds specified by current legislation.

1.7. The subject of personal data may at any time withdraw his consent to the processing of personal data, provided that such a procedure does not violate the requirements of the legislation of the Russian Federation, by sending an email to

1.8. If the Personal Data Subject withdraws consent to the processing of his personal data, the Company must stop processing it and, if the storage of personal data is no longer required for the purposes of its processing, destroy the personal data within a period not exceeding 30 (Thirty) days from the date of receipt the said revocation, unless otherwise provided by the agreement to which the Personal Data Subject is a party, beneficiary or guarantor, another agreement between the Company and the Personal Data Subject, or if the Company does not have the right to process personal data without the consent of the Personal Data Subject on the grounds provided for by the Federal Law No. 152-FZ “On Personal Data” dated July 27, 2006 or other federal laws.

2. CONCEPT AND COMPOSITION OF PERSONAL DATA

2.1. For the purposes of this Policy, personal data means any information relating directly or indirectly to a specific or identifiable individual (subject of personal data)

2.2. Depending on the subject of personal data, the Company, in order to carry out its activities and fulfill its obligations, may process personal data of the following categories of subjects:

• personal data of the Company’s employees (information required by the Company in connection with labor relations and relating to a specific employee);
• personal data of affiliated persons or personal data of a manager or employee of a legal entity that is an affiliate of the Company (information necessary for the Company to record in documents on the Company’s activities in accordance with the requirements of the Federal Law “On Limited Liability Companies”, other federal laws and regulations legal acts);
• personal data of managers, participant (shareholder) or employee of a legal entity that is a counterparty of the Company (information necessary for the Company to fulfill its obligations under contractual relations with counterparties/partners to comply with the requirements of the current legislation of the Russian Federation).
• personal data of the Client (information necessary for the Company to fulfill its obligations under the contractual relationship with the Client and to comply with the requirements of the current legislation of the Russian Federation).

2.3. The company processes the following personal data:

• Full Name;
• phone number;
• E-mail address;
• data on the services provided and provided to the Personal Data Subject, including the Subject’s order history;
• history of requests from the Personal Data Subject, including documents sent by the Subject when contacting the Company.

2.4. When using the services of the site www.medq.ru, the Company also processes other anonymized data that is automatically transmitted during the use of the site through software installed on the computer:

• information about the browser used (or other program used to access the site);
• IP address;
• cookie data;

2.5. The Company guarantees that organizations external to the Company do not have access to such data that can be used by the Company, except in cases expressly provided for by the current legislation of the Russian Federation and this Policy, as well as expressly provided for in the Offer. Upon receipt of personal data not specified in this section, such data is subject to immediate destruction.

2.6. Consent to the processing of personal data is considered to be provided through the performance by the Personal Data Subject of any action or combination of the following actions:

• filling out a document on paper at the Company;
• placing an order on the Company’s Website;
• placing on the Site in the appropriate form a mark indicating consent to the processing of personal data to the extent, for the purposes and in the manner provided for in the text proposed for review before obtaining consent;
• communication of personal data orally, when contacting the call center by phone during the ordering process.

2.7. Consent is considered received in the prescribed manner and is valid until the Personal Data Subject sends a corresponding application to terminate the processing of personal data at the location of the Company or in another way provided for in the Offer.

3. GROUNDS AND PURPOSE OF PROCESSING PERSONAL DATA

3.1. The company processes personal data to carry out its activities, realize its legitimate interests and requirements.

3.2. The purpose of processing personal data is the need to carry out the functions assigned to the Company by the legislation of the Russian Federation in accordance with the Federal Law “On Personal Data”, the Labor Code of the Russian Federation, the Federal Law “On combating the legalization (laundering) of proceeds from crime and the financing of terrorism”, “On individual (personalized) accounting in the compulsory pension insurance system”, other laws and regulations of the Russian Federation, as well as the Charter and regulations of the Company.

3.3. The Company processes personal data of Personal Data Subjects by maintaining databases using automated, mechanical, and manual methods for the purposes of:

A) processing orders, requests or other actions of the Personal Data Subject related to the purchase of participation in events, incl. for notification of cancellation, replacement or postponement of events, the procedure for returning funds for canceling an event, gift vouchers, sending other information messages regarding events for which the Personal Data Subject purchased, etc.;

B) in the case of the expressed consent of the Personal Data Subject, in order to promote the Company’s goods, works and services on the market, notify about ongoing promotions, events, discounts, and conduct marketing campaigns of the Company and its partners.

C) for other purposes if the relevant actions of the Company do not contradict current legislation, and the consent of the Personal Data Subject has been obtained for the said processing.

D) the data specified in the paragraphs of this Policy are processed for the purpose of performing analytics on the Site, improving the functioning of the Site, solving technical problems of the Site, developing new products, expanding services; ensuring security and preventing fraud, providing effective customer support.

The company processes personal data by performing any action, including the following collection, recording, systematization, accumulation, storage, use, transfer (distribution, provision, access), depersonalization, blocking, deletion, destruction.

Also, the Company, in addition to Client data, collects and stores the employee’s personal data necessary to fulfill the terms of the employment contract and exercise rights and obligations in accordance with labor legislation, including to ensure compliance with the Tax Code of the Russian Federation, “On individual (personalized) accounting in the compulsory pension system insurance."

4. TERMS FOR PROCESSING PERSONAL DATA

4.1. The terms of processing of personal data are determined based on the purposes of processing in the Company’s information systems, in accordance with the validity period of the contract, agreement with the subject of personal data, with the List of standard management documents generated in the course of the activities of state bodies, local governments and organizations, indicating storage periods (approved by the Ministry of Culture of the Russian Federation, Order No. 558 of August 25, 2010), the limitation period, as well as other legal requirements and regulatory documents of the Company, taking into account the provisions of clause 4.2. of this Policy.

4.2. The total storage period for Clients’ personal data should not exceed 5 (five) years.

5. PERSONS AUTHORIZED TO PROCESS PERSONAL DATA

5.1. Only those Company employees who are assigned such a duty in accordance with their official (labor) responsibilities are allowed to process personal data. Access to other employees may only be granted in cases provided by law. The company requires its employees to maintain confidentiality and ensure the security of personal data when processing it, and also establishes liability for violation of the requirements for the processing of personal data.

5.2. The company has the right to transfer personal data to third parties in the following cases:

• The subject of personal data has clearly expressed his consent to such actions;
• The transfer is provided for by Russian or other applicable legislation within the framework of the procedure established by law;
• The transfer occurs as part of the sale or other transfer of a business (in whole or in part). In this case, all obligations to comply with the terms of this Policy in relation to the data received by him are transferred to the acquirer.
• The transfer is necessary to fulfill the obligations of the event organizer to the Client, including ensuring admission, insurance, parking, etc., as well as to carry out the delivery of Tickets in the event that delivery is carried out by third parties or ticket sellers.

6. METHODS OF PROCESSING PERSONAL DATA

6.1. In the process of providing services, when carrying out intra-business activities, the Company uses automated, using computer technology, and non-automated, using paper document flow, processing of personal data.

6.2. The Company does not make decisions that give rise to legal consequences in relation to the subject of personal data or otherwise affect his rights and legitimate interests based solely on automated processing of personal data.

6.3. Confidentiality is maintained with respect to the user's personal information, except in cases where the user voluntarily provides information about himself for public access to an unlimited number of persons. In this case, the user agrees that a certain part of his personal information becomes publicly available.

6.4. The company guarantees organizational and technical measures to protect the user’s personal information from unauthorized or accidental access, destruction, modification, blocking, copying, distribution, as well as from other unlawful actions of third parties.

7. PROTECTION OF PERSONAL DATA

7.1. The Company’s activities in processing personal data in information systems are inextricably linked with the Company’s protection of the confidentiality of the information received. All Company employees are obliged to ensure the confidentiality of personal data, as well as other information established by the Company, unless this contradicts the current legislation of the Russian Federation.

7.2. The security of personal data when processed in the Company’s information systems is ensured using an information protection system, which includes: organizational measures using restrictions on physical access to premises, the use of software and hardware protection measures (including encryption (cryptographic) means, means of preventing unauthorized access, and software and hardware impact on technical means of processing personal data.

7.3. In order to ensure the security of personal data during its processing, the Company takes the necessary legal, organizational and technical measures to protect personal data from unauthorized or accidental access, destruction, modification, blocking, copying, provision, distribution of personal data, as well as from other unlawful actions in relation to them, including:

• identification of threats to the security of personal data during their processing in personal data information systems;
• application of organizational and technical measures to ensure the security of personal data during their processing in personal data information systems necessary to fulfill the requirements for the protection of personal data, the implementation of which ensures the levels of personal data security established by the Government of the Russian Federation;
• use of information security means that have passed the compliance assessment procedure in accordance with the established procedure;
• detecting facts of unauthorized access to personal data and taking measures;
• restoration of personal data modified or destroyed due to unauthorized access to it;
• timely detection of facts of unauthorized access to personal data and taking the necessary measures;
• control over the measures taken to ensure the security of personal data and the level of security of personal data information systems.

7.4 In order to ensure compliance of the level of personal data protection with the requirements of the Federal Law of July 27, 2006 No. 152-FZ “On Personal Data” and the Federal Law of July 27, 2006 No. 149-FZ “On Information, Information Technologies and Information Protection,” the Company does not disclose information on the specific means and measures used to ensure information security of personal data.

8. PROTECTION OF PERSONAL DATA

8.1. This Policy is approved by order of Individual Entrepreneur Vladimir Yuryevich Biryukov and comes into force from the date of its signing.

8.2. Changes and additions may be made to this Policy, which are approved by order of Individual Entrepreneur Vladimir Yuryevich Biryukov.

8.3. The current version of the Policy is posted on the Internet at the following address: www.medq.ru