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

PURPOSE: TO establish the frequency with which serum ferritin levels g reater than or equal to 1,000 ng/mL occur in a general hospital popula tion, and to determine the clinical significance of this finding. PATI ENTS 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 patient s were then reviewed. RESULTS: Of 1,826 serum ferritin determinations performed during the study period, 122 (6.7%) were greater than or equ al to 1,000 ng/mL. Associated clinical syndromes found in the 95 patie nts 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 syste mic infections (15.8%), chronic transfusions (10.5%), and sickle cell syndromes (10.5%). No syndrome usually associated with extreme serum f erritin elevations was identified in 8.4% of patients, and 16.8% of th e patients fell into more than one category. The highest mean serum fe rritin levels occurred in the chronically transfused and sickle cell g roups. Concomitant serum transferrin saturation values were determined with 82 (86.3%) of the elevated serum ferritin levels and did not cor relate well with them. The highest mean transferrin saturation levels occurred in the liver disease group. Transferrin saturation greater th an or equal to 50%, suggestive of iron overload, was significantly mor e frequent in the liver disease group (P = 0.002); and saturation less than or equal to 15%, suggestive of iron-deficient: erythropoiesis, w as significantly more frequent in the HIV group (P = 0.001). CONCLUSIO N: Outside the setting of clinical syndromes associated with iron over load (liver disease, transfusions, sickle cell syndromes), serum ferri tin levels greater than or equal to 1,000 ng/mL serve as a nonspecific marker for a variety of significant