Ferritin is an iron storage protein. It is the primary iron storage mechanism and is critical to iron homeostasis. As an iron store, ferritin has two roles ¹.

1. Provides a reserve of iron, which can be transported for the synthesis of molecules such as cytochromes, haemoglobin and iron-sulphur compounds.
2. Safe-guards cells, DNA, lipids and proteins from the potential toxic effects of iron.

Ferritin is a vital component of iron homeostasis. It acts as as a ferroxidase, converting Fe(II) to Fe(III) as iron is internalised and sequestered in the ferritin mineral core. Iron is toxic in cellular systems due to its capacity to generate reactive oxygen species (ROS) which directly damages cells, DNA, lipids and proteins ¹.

Adult onset Still’s Disease (AOSD) is a rare systemic inflammatory disorder characterised by arthritis, fever and a typical skin rash. Elevated ferritin levels have been observed in 89% of patients with AOSD, with five times the normal level observed in over half of patients ³.

Elevated ferritin levels is associated with a poor outcome in patients with sepsis and can be used as a predictive marker of mortality along with current prognostic scores ⁴. Elevations of both ferritin and CRP during hospitalisation was associated with the highest mortality, followed by elevations of either biomarker alone (fig. 1) ⁵.

Fig. 1. Risk contingency table for mortality and organ dysfunction based on cut-points for C-reactive protein and ferritin and patients’ maximum value for each biomarker ⁵

Data is displayed as n / N (%) for mortality outcomes

*Significant difference in high/intermediate versus low risk quadrants; {<0.001 by Mann-Whitney test PELOD2, Pediatric Logistic Organ Dysfunction Score 2

Ferritin is the most important acute phase reactant in the prediction of classical Hodgkin lymphoma (cHL). Ferritin correlates with the inflammatory activity of the cHL microenvironment, which could explain its prognostic impact. Elevated ferritin levels are associated with clinical features of aggressive disease and poor prognosis in cHL patients ⁶.