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CPE-004 · Scope and validity
ID-VAL-01: Inflammation changes how ferritin is read
Inflammation changes how ferritin is read. Evaluates inflammation documented, OR hs-CRP above 5 mg/L.
Condition
- inflammation documented, OR hs-CRP above 5 mg/L
What it reports
- Ferritin is an acute-phase reactant: a normal or high value no longer excludes iron deficiency
- Ferritin cutoffs shift (<70 ng/mL, WHO) and transferrin saturation is weighed alongside
Diagnostic boundary
- Does not diagnose iron deficiency; it widens the question.
Evidence
- EV-WHO-FERR-2020World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO; 2020.Supports: Ferritin below 15 µg/L indicates iron deficiency in healthy adults A higher cutoff (<70 µg/L) applies in the presence of infection or inflammation
- EV-AHA-HF-2022Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032.Supports: Iron deficiency in heart failure: ferritin <100 ng/mL, or 100–299 ng/mL with transferrin saturation <20%
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
IRON-FX-05
Rheumatoid arthritis: ferritin 85, TSAT 12
Hb 10.4 with a ferritin that looks normal and a CRP of 18.
IRON-FX-06
Inflammation with ferritin 48 and TSAT 9
Ferritin looks near normal but sits under the WHO inflammation cutoff of 70.
IRON-FX-16
Ferritin 1,450 during inflammation
A very high ferritin with a CRP of 60.
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