Plasma Ferritin in Acute Hepatocellular Damage

Plasma ferritin concentrations are increased in iron overload, liver diseases, infections, inflammatory conditions, and malignancy. Very high concentrations (>10 000 μg/L) have been described in Still disease (1) and less commonly in hemochromatosis. There are very few reports of ferritin concentrations in patients with acute hepatocellular damage (AHD). A review of extreme increases in ferritin found that liver disease was the cause of 20% of cases but did not specify actual concentrations seen and did not differentiate acute and chronic liver disease (2). We have determined ferritin concentrations in AHD patients. Plasma ferritins were measured in eight patients who had plasma alanine aminotransferase (ALT) values <100 U/L pre-AHD and >1000 U/L post-AHD. ALT, iron, and transferrin were measured on a Hitachi 917 (Roche Diagnostics), and ferritin was measured on the ACS:180 (Bayer Diagnostics). The results for individual patients are shown in Table 1 . In one patient, serum ferritin did not exceed the upper limit of the reference interval during AHD. This patient was iron-deficient with a basal ferritin of 22 μg/L. The plasma ALT increased from a basal mean (SD) of 45 (29) U/L to 2970 (1540) U/L during AHD, and ferritin increased from 200 (130) μg/L to 18 260 (17 860) μg/L. The mean plasma iron increased from 12 (11) μmol/L to 16 (19) μmol/L, transferrin decreased from 27 (11) μmol/L to 22 (7) μmol/L, and transferrin saturation increased from 18% (7%) to 31% (30%). The rapid increase in ferritin in AHD suggests that ferritin is present in the cytosol of the hepatocytes. There was significant (P <0.01) correlation between the increase in ALT and ferritin in AHD. Despite the marked increase in ferritin in five of six patients in whom iron and transferrin were measured, the transferrin saturation increased above the reference interval in only one of these patients. In conclusion, ferritin concentrations were markedly increased after AHD and are of no diagnostic value during this time. These data imply that ferritin and ALT are present in the cytosol of the hepatocytes. Plasma ferritin in AHD.1 Reference intervals: ALT <40 U/L; ferritin, 30–500 μg/L for males, 20–200 μg/L for females <50 years, 30–300 μg/L for females >50 years; iron, 10–30 μmol/L for males, 9–29 μmol/L for females; transferrin, 23–43 μmol/L for males, 23–46 μmol/L for females; transferrin saturation, 14–53% for males, 13–48% for females. Trf, transferrin; Trf Sat, transferrin saturation. Plasma ferritin in AHD.1 Reference intervals: ALT <40 U/L; ferritin, 30–500 μg/L for males, 20–200 μg/L for females <50 years, 30–300 μg/L for females >50 years; iron, 10–30 μmol/L for males, 9–29 μmol/L for females; transferrin, 23–43 μmol/L for males, 23–46 μmol/L for females; transferrin saturation, 14–53% for males, 13–48% for females. Trf, transferrin; Trf Sat, transferrin saturation.