Elevated serum ferritin is a marker of macrophage activation and is associated with increased mortality. The hyperferritinemic syndromes which include hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS), catastrophic antiphospholipid syndrome (CAPS), septic shock, adult-onset Still's Disease (AOSD), and multi-inflammatory syndrome related to COVID-19 (MIS-C/A) are characterized by intense inflammation and its sequalae. Prompt recognition and management of these heterogenous disorders is required to improve patient outcomes. We perform a scoping review of the existing literature on the key features of these rare syndromes.
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http://dx.doi.org/10.56305/001c.37667 | DOI Listing |
Clin Appl Thromb Hemost
February 2025
Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Objective: Markedly elevated serum ferritin serves as a laboratory marker of macrophage activation syndrome and is associated with increased mortality in sepsis, where hyperinflammation, coagulopathy, and immune dysregulation interplay. Although laboratory studies suggest a relationship between hyperferritinemia and coagulopathy in sepsis, clinical evidence remains limited. This study aims to assess mortality risk and the interplay between hyperferritinemia (ferritin ≥ 500 ng/mL) and thrombocytopenia in two sequential cohorts of adult patients with sepsis.
View Article and Find Full Text PDFIsr Med Assoc J
October 2024
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
J Clin Immunol
September 2024
Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
High ferritin is an important and sensitive biomarker for the various forms of hemophagocytic lymphohistiocytosis (HLH), a diverse and deadly group of cytokine storm syndromes. Early action to prevent immunopathology in HLH often includes empiric immunomodulation, which can complicate etiologic work-up and prevent collection of early/pre-treatment research samples. To address this, we instituted an alert system at UPMC Children's Hospital where serum ferritin > 1000 ng/mL triggered real-time chart review, assessment of whether the value reflected "inflammatory hyperferritnemia (IHF)", and biobanking of remnant samples from consenting IHF patients.
View Article and Find Full Text PDFAdv Exp Med Biol
August 2024
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
There is extensive overlap of clinical features among familial or primary HLH (pHLH), reactive or secondary hemophagocytic lymphohistiocytosis (sHLH) [including macrophage activation syndrome (MAS) related to rheumatic diseases], and hyperferritinemic sepsis-induced multiple organ dysfunction syndrome (MODS); however, the distinctive pathobiology that causes hyperinflammatory process in each condition requires careful considerations for therapeutic decision-making. pHLH is defined by five or more of eight HLH-2004 criteria [1], where genetic impairment of natural killer (NK) cells or CD8+ cytolytic T cells results in interferon gamma (IFN-γ)-induced hyperinflammation regardless of triggering factors. Cytolytic treatments (e.
View Article and Find Full Text PDFEur J Haematol
November 2024
Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, Canada.
Objective: Adult-onset Still's disease (AOSD) and secondary hemophagocytic lymphohistiocytosis (sHLH) are both hyperferritinemic cytokine storm syndromes that can be difficult to distinguish from each other in hospitalized patients. The objective of this study was to compare the inflammatory markers ferritin, D-dimer, C-reactive protein (CRP), and soluble CD25 (sCD25) in patients with AOSD and sHLH. These four markers were chosen as they are widely available and represent different aspects of inflammatory diseases: macrophage activation (ferritin); endothelialopathy (D-dimer); interleukin-1/interleukin-6/tumour necrosis factor elevation (CRP) and T cell activation (sCD25).
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