Causes of low ferritin levels
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Causes of Low Ferritin Levels
Celiac Disease and Low Ferritin Levels
Celiac disease (CD) is a significant cause of low ferritin levels. CD is a genetic disorder that impairs nutrient absorption in the small intestine, leading to iron deficiency. This condition is particularly noted in patients with restless legs syndrome (RLS), where low ferritin levels exacerbate RLS symptoms. In a study, patients with RLS and low serum ferritin were found to have CD, confirmed by duodenal biopsy. Treatment with a gluten-free diet improved their ferritin levels and RLS symptoms, suggesting that CD should be considered in patients with unexplained low ferritin levels.
Genetic Mutations and Ferritin Levels
Genetic mutations can also lead to low ferritin levels. A specific mutation in the FTL gene (c.473T>C; p.Pro158Leu) was identified in a family with low serum ferritin but normal other iron parameters. This mutation affects the ferritin protein's ability to store iron, leading to unmeasurable serum ferritin levels despite normal iron levels in the body. This highlights the role of genetic factors in ferritin metabolism and iron storage.
Iron Deficiency and Restless Legs Syndrome
Iron deficiency is a well-known cause of low ferritin levels and is closely associated with the severity of RLS. A meta-analysis revealed that patients with RLS and low ferritin levels are at a higher risk of experiencing augmentation, a worsening of symptoms due to dopaminergic treatment. Iron supplementation in these patients not only alleviates RLS symptoms but also reduces the risk of augmentation, emphasizing the importance of maintaining adequate ferritin levels in managing RLS.
Ferritin Levels in Parkinson's Disease
In Parkinson's disease, decreased ferritin levels have been observed in various brain regions, including the substantia nigra and cerebral cortex. This reduction in ferritin levels does not correspond to serum ferritin levels, which remain normal. The exact mechanism behind this localized decrease in brain ferritin is unclear but suggests a defect in iron handling within the brain, contributing to the pathology of Parkinson's disease.
Ferritin and Heart Failure Risk
Low ferritin levels are associated with an increased risk of heart failure (HF). A study from the Atherosclerosis Risk in Communities (ARIC) study found that individuals with low ferritin levels had a higher incidence of HF compared to those with normal ferritin levels. This association persisted even in the absence of anemia, indicating that iron deficiency, as reflected by low ferritin, may play a role in the development of HF.
Ferritin in Pregnancy-Related Anemia
During pregnancy, low ferritin levels are a common indicator of iron deficiency anemia. Serum ferritin measurement is a reliable diagnostic tool, correlating well with bone marrow iron content. It is particularly useful in differentiating between iron deficiency anemia and anemia due to infection, as ferritin levels are typically elevated in the latter. This makes ferritin a critical marker in managing anemia in pregnant women.
Conclusion
Low ferritin levels can result from various causes, including celiac disease, genetic mutations, iron deficiency, and specific conditions like restless legs syndrome and Parkinson's disease. Additionally, low ferritin is a significant risk factor for heart failure and a key diagnostic marker for anemia during pregnancy. Understanding these underlying causes is crucial for effective diagnosis and treatment, ensuring better health outcomes.
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