How should hyperferritinaemia be investigated and managed?

• Hyperferritinaemia is a common clinical finding not always due to iron overload.
• Inflammatory and infective processes can also cause hyperferritinaemia.
• Physical and demographic factors are important in interpreting serum ferritin.
• Investigations are required to establish if there is true iron overload.
• The most common cause of iron overload is hereditary haemochromatosis.

Hyperferritinaemia is commonly found in clinical practice. In assessing the cause of hyperferritinaemia, it is important to identify if there is true iron overload or not as hyperferritinaemia may be seen in other conditions such as excess alcohol intake, inflammation and non-alcoholic fatty liver disease. Assessment of whether the serum ferritin level is elevated or not should take into account body mass index, gender and age. This review article provides an overview of the different causes of hyperferritinaemia, differentiating those due to iron overload from those not due to iron overload, and provides an algorithm for clinicians to use in clinical practice to carry out appropriate investigations and management.