title: Conditions associated with extreme hyperferritinaemia (>3000 μg/L) in adults.
abstract: BACKGROUND
  The clinical significance of extreme hyperferritinaemia has come under scrutiny with the increasing recognition of haemophagocytic lymphohistiocytosis (HLH) in adults. Most studies of hyperferritinaemia have focused on serum ferritin greater than 1000 μg/L, often in ambulatory patients. The conditions associated with more extreme hyperferritinaemia are poorly understood.
  
  
  OBJECTIVE
  To examine conditions associated with extreme hyperferritinaemia greater than 3000 μg/L in acutely ill adults at a quaternary care hospital.
  
  
  METHODS
  Patients with serum ferritin greater than 3000 μg/L at Vancouver General Hospital between 1 August 2011 and 1 August 2012 were identified. Those over 18 years of age and with clinical data available were included in the study.
  
  
  RESULTS
  Eighty-three subjects were identified. Twenty-one cases (25%) were due to transfusional iron overload, 16 (19%) due to liver disease and 15 (18%) due to mixed factors. Haemophagocytic lymphohistiocytosis (HLH) was diagnosed in six of 83 patients (7%) with ferritin greater than 3000 μg/L, but six of eight patients (75%) with ferritin greater than 20 000 μg/L.
  
  
  CONCLUSIONS
  Extreme hyperferritinaemia greater than 3000 μg/L is uncommon in adult patients. The highest serum ferritin values are seen in HLH, but the differential diagnosis for serum ferritin greater than 3000 μg/L remains broad with iron overload and liver disease being the most common causes.
authors: Department of Medicine, University of British Columba, Vancouver, Canada.
authors: A J
authors: AJ
authors: Wormsbecker
authors: Department of Medicine, University of British Columba, Vancouver, Canada.|Department of Emergency Medicine, University of British Columba, Vancouver, Canada.
authors: D D
authors: DD
authors: Sweet
authors: Department of Medicine, University of British Columba, Vancouver, Canada.
authors: S L
authors: SL
authors: Mann
authors: Department of Medicine, University of British Columba, Vancouver, Canada.
authors: S Y
authors: SY
authors: Wang
authors: Department of Pathology and Laboratory Medicine, University of British Columba, Vancouver, Canada.
authors: M R
authors: MR
authors: Pudek
authors: Department of Medicine, University of British Columba, Vancouver, Canada.
authors: L Y C
authors: LY
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003937:Diagnosis, Differential; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D019190:Iron Overload / Q000097:blood*; D008107:Liver Diseases / Q000150:complications; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005293:Ferritins
keywords: ferritin; haemophagocytic lymphohistiocytosis; hyperferritinaemia