[Differential diagnosis of hyperferritinemia]

Hyperferritinemia is a common finding in clinical practice, and its origin is associated with more than one etiology in 40% to 70% of cases. This multifactorial nature requires a comprehensive differential diagnostic approach. A thorough clinical evaluation is crucial to guide the diagnosis, as seric ferritin (SF) is also an acute phase reactant and can act as a biomarker in diseases where inflammation is central. Most cases with elevated FTs do not have iron overload. It is essential to distinguish iron overload from other causes of hyperferritinemia, as the management, treatment, and prognosis differ markedly. For this purpose, a transferrin saturation (STf) greater than 40-45% is useful for discrimination. With SF levels above 1000 ng/mL, evaluation for liver fibrosis is recommended, either by elastography, imaging studies, or liver biopsy. In patients without an identified cause, monitoring SF and STf levels over time can provide guidance on the etiology. Stability or a decrease in levels reduces the likelihood of an iron overload disease.