TY - JOUR
T1 - Extreme hyperferritinemia
T2 - Causes and impact on diagnostic reasoning
AU - Sackett, Katie
AU - Cunderlik, Maros
AU - Sahni, Nishant
AU - Killeen, Anthony
AU - Olson, Andrew P
N1 - Publisher Copyright:
© American Society for Clinical Pathology, 2016. All rights reserved.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Objectives: Hyperferritinemia can be a result of inflammation, infection, chronic iron overload, or other uncommon pathologies including hemophagocytic lymphohistiocytosis (HLH). There is a historical association between extreme hyperferritinemia and HLH, but in reality HLH is associated with a minority of hyperferritinemic states. Methods: We identified conditions most associated with hyperferritinemia by identifying 65, 536 serum ferritin levels at the University of Minnesota Hospital over a five-year period, with 86 values higher than 10, 000 ng/mL. Pediatric patients comprised 22% of this population, and adults, 78%. Results: The majority of cases in both populations with hyperferritinemia were due to chronic transfusion (35%), followed by liver disease (27%), and hematologic malignancy (16%). Solid malignancies, infection, macrophage activation syndrome, and primary and secondary HLH comprised the remaining (22%). Conclusions: Although this supports the relationship between extreme hyperferritinemia and HLH, it maintains that the positive predictive value of hyperferritinemia for HLH is quite low, and one should consider more common explanations before suspecting HLH.
AB - Objectives: Hyperferritinemia can be a result of inflammation, infection, chronic iron overload, or other uncommon pathologies including hemophagocytic lymphohistiocytosis (HLH). There is a historical association between extreme hyperferritinemia and HLH, but in reality HLH is associated with a minority of hyperferritinemic states. Methods: We identified conditions most associated with hyperferritinemia by identifying 65, 536 serum ferritin levels at the University of Minnesota Hospital over a five-year period, with 86 values higher than 10, 000 ng/mL. Pediatric patients comprised 22% of this population, and adults, 78%. Results: The majority of cases in both populations with hyperferritinemia were due to chronic transfusion (35%), followed by liver disease (27%), and hematologic malignancy (16%). Solid malignancies, infection, macrophage activation syndrome, and primary and secondary HLH comprised the remaining (22%). Conclusions: Although this supports the relationship between extreme hyperferritinemia and HLH, it maintains that the positive predictive value of hyperferritinemia for HLH is quite low, and one should consider more common explanations before suspecting HLH.
KW - Clinical pathology
KW - Hematology
KW - Hematopathology
KW - Transfusion medicine
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U2 - 10.1093/AJCP/AQW053
DO - 10.1093/AJCP/AQW053
M3 - Article
C2 - 27247369
AN - SCOPUS:84982182008
SN - 0002-9173
VL - 145
SP - 646
EP - 650
JO - American journal of clinical pathology
JF - American journal of clinical pathology
IS - 5
ER -