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Can Ferritin increase be from an injured swollen elbow or osteoarthritis?

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Posted on Fri, 16 Oct 2020
Question: Last October on a routine physical I received a ferritin reading of 535 with all other cbc/metabolic panel tests and Iron panel completely normal. A follow up 6 weeks later still showed a raised ferritin of 448 and yet another showed 2 weeks after that at 575 (At time of the 575 value My CRP was normal, less than .4, and my ESR was 2mm/hr.) I was referred to a hematologist who one week later did a Ferritin test (different lab) and my result came back at 341 and 1 month later at 368. My TIBC averages around 275 and Iron around 108. TS% usually 39%.

The hematologist also tested me for the HFE gene, negative, ANA negative, various viruses like hepatitis, and did another ESR which came back at 4mm/hr. I had an abdominal u/s that was unremarkable with the exception of some renal cysts and repeated metabolic panels and CBCs with normal results.

I am a 42 year old very fit male with a BMI of around 24.

Can ferritin increase from an injured swollen elbow or osteoarthritis?

Is there much variation amongst labs measuring Ferratin (575 down to 341 in 6 days seems like a lot)?

I'm trying to get to the bottom of these results. I have no real symptoms of other disease.

Could my levels be a result of something serious considering the normal CRP,ESR,ANA and other blood work? Any other workup to be done other than follow up to check levels?

One other thing, I do consume 4-5 meals per day and do eat iron rich foods. Could this be a factor considering the data I presented? Any other info you need? Thank you!
doctor
Answered by Dr. Prof. Kunal Saha (5 hours later)
Brief Answer:
Ferritin is inflammatory marker and could be raised due to osteoarthritis

Detailed Answer:

Hi,

I have gone carefully through the entire details. Your TIBC is normal and ferritin is raised. Ferritin is an inflammatory marker and can rise in inflammatory conditions including swollen elbow or osteoarthritis. The variation in the levels of ferritin does not look significant and you need not be concerned about it. In absence of other inflammatory markers like CRP and ANA it would be advisable to visit a rheumatologist and get your osteoarthritis treated. Treatment of the underlying condition should automatically bring down the ferritin levels. I would not suggest any other work up at the moment.

Whether you take iron rich foods would not really be a cause for concern as the problem does not lie there.

Feel free to write back.

Regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Prof. Kunal Saha (3 hours later)
Thanks Dr.

I have two questions.

What was confusing to me was the normal crp and ESR that occured at the same time as the higher ferritin value. Could this still be a swollen elbow and these other inflammatory markers not be raised?

My main concern is that it could be do to malignancy as I cant really pinpoint any symptoms but would normal CRP,ANA, ESR and ultrasound as well as the fact that no symptoms have appeared in over 6 mos pretty much rule this out? My doctors arent too concerned as my last values were within the upper limits of normal according to some labs.
doctor
Answered by Dr. Prof. Kunal Saha (1 hour later)
Brief Answer:
Swollen elbow and osteoarthritis still the most likely contributors

Detailed Answer:
Yes, not all inflammatory markers need to be simultaneously elevated. Malignancy is indeed a valid possibility but in absence of any definitive presentation I would not worry about it.

Forget the values. Get the osteoarthritis treated. See how that changes things.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Prof. Kunal Saha (4 hours later)
Thanks Dr., last question, is it possible levels just under 400 are normal for me and may not have any cause other than the way my body stores iron and my not have clinical significance?
doctor
Answered by Dr. Prof. Kunal Saha (11 hours later)
Brief Answer:
You need not get too concerned

Detailed Answer:
I would not really consider the levels to be normal irrespective of whether we can find a clinical significance. However, I would insist you not to be bothered by it. Since you already have a condition that could precipitate the elevation in ferritin level, treating it (osteoarthritis) would be all you need to do.

Regards
Above answer was peer-reviewed by : Dr. Remy Koshy
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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4470 Questions

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Can Ferritin increase be from an injured swollen elbow or osteoarthritis?

Brief Answer: Ferritin is inflammatory marker and could be raised due to osteoarthritis Detailed Answer: Hi, I have gone carefully through the entire details. Your TIBC is normal and ferritin is raised. Ferritin is an inflammatory marker and can rise in inflammatory conditions including swollen elbow or osteoarthritis. The variation in the levels of ferritin does not look significant and you need not be concerned about it. In absence of other inflammatory markers like CRP and ANA it would be advisable to visit a rheumatologist and get your osteoarthritis treated. Treatment of the underlying condition should automatically bring down the ferritin levels. I would not suggest any other work up at the moment. Whether you take iron rich foods would not really be a cause for concern as the problem does not lie there. Feel free to write back. Regards