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In Reply Dr Lippi raises the important point that an elevated serum ferritin level may also be associated with underlying malignancy; it is true that ferritin may be elevated in a broad variety of other disease processes, as we noted in our JAMA Diagnostic Test Interpretation article. Elevated serum ferritin levels are commonly encountered in general practice and many elevations may be due to non–iron overload conditions.
The patient described was a relatively healthy middle-aged man who was unexpectedly noted to have a markedly elevated ferritin level. The cited investigation by Moore et al1 retrospectively studied the underlying etiology of markedly elevated serum ferritin levels in a large group of patients at a tertiary care medical center, including patients with a range of cancers, infections, inflammatory conditions, and renal diseases.1 This study population is distinctly different from the relatively healthy patient described in our article.
VanWagner LB, Green RM. Causes of Ferritin Elevation. JAMA. 2014;312(23):2572. doi:10.1001/jama.2014.14964