The ferritin test may be ordered, along with other iron tests, when a routine CBC shows that a person's hemoglobin andhematocrit are low and their red blood cells are smaller and paler than normal (microcytic and hypochromic), suggesting Iron deficiency anemia As iron stores continue to be depleted, there may be shortness of breath, ringing in the ears (tinnitus), drowsiness, and irritability. If the anemia progresses in severity, chest pain, headaches, leg pains, shock, and even heart failure may occur. Children may develop learning (cognitive) disabilities. Besides the general symptoms of anemia, there are certain symptoms that are characteristic of iron deficiency. These include pica (cravings for specific substances, such as licorice, chalk, dirt, or clay), a burning sensation in the tongue or a smooth tongue, sores at the corners of the mouth, and spoon-shaped finger- and toe-nails. A ferritin level is also ordered when iron overload is suspected. Symptoms of iron overload will vary from person to person and tend to worsen over time. They are due to iron accumulation in the blood and tissues. Symptoms may include: Joint pain, Fatigue ,weakness , Weight loss , Lack of energy , Abdominal pain, Loss of sex drive, Loss of body hair,Heart problems such as congestive heart failure (CHF) To confirm the presence of iron overload, other iron tests (iron, TIBC) and a genetic test for hereditary hemochromatosismay be ordered as well. . A summary of the changes in iron tests seen in various diseases of iron status is shown in the table below. Disease Iron TIBC/Transferrin UIBC %Transferrin Saturation Ferritin Iron Deficiency Low High High Low Low Hemochromatosis High Low Low High High Chronic Illness Low Low Low/Normal Low Normal/High Hemolytic Anemia High Normal/Low Low/Normal High High Sideroblastic Anemia Normal/High Normal/Low Low/Normal High High Iron Poisoning High Normal Low High Normal Ferritin is an acute phase reactant and can be increased in people with inflammation, liver disease, chronic infection,autoimmune disorders, and some types of cancer. Normally, most ferritin is found inside of cells with only a small amount in the blood. When there is damage to organs that contain ferritin, such as the liver, spleen, and bone marrow, ferritin levels can become elevated even though the total amount of iron in the body is normal.