Updating the diagnosis and management of elevated serum ferritin levels in the era of routine ferritin testing of blood donors by Australian Red Cross Lifeblood

Elevated serum ferritin levels (hyperferritinaemia) can reflect a wide range of conditions and are not solely indicative of iron overload. A thorough clinical assessment is required to identify serious causes of high serum ferritin levels, evaluate iron status and manage associated complications.

The upper limit of the reference interval for serum ferritin values varies between laboratories due to different testing methods, and the Royal College of Pathologists of Australasia no longer specifies upper limits in its guidance to laboratories. Up to 20% of men have elevated serum ferritin concentrations, while the prevalence in women varies from 3% in premenopausal women to 17% in women older than 70 years. Less than 10% of cases of hyperferritinaemia are due to iron overload.

In August 2023, the Australian Red Cross Lifeblood introduced routine ferritin testing for its new blood donors (over 100 000 people per year), with plans to expand testing to all whole blood donors. Donors are formally advised if their results are outside the sex-based reference intervals of 15–400 μg/L for female donors and 30–500 μg/L for male donors. Based on Australian adult population data, about 10% of men and 2% of women will exceed these upper limit thresholds of serum ferritin levels. This will likely result in a considerable increase in adults with elevated serum ferritin levels being identified and referred to their primary care physician for evaluation. This medical education article provides a guide for the investigation and management of elevated serum ferritin levels.