Serum ferritin is a cost-effective laboratory marker for hemophagocytic lymphohistiocytosis in the developing world

J Pediatr Hematol Oncol. 2012 Apr;34(3):e89-92. doi: 10.1097/MPH.0b013e31824227b9.


Hemophagocytic lymphohistiocytosis (HLH) is a rare disease in children and presents many diagnostic difficulties. Without prompt intervention, the disease typically runs a rapidly fatal course. Diagnostic criteria were proposed by the Histiocyte Society in 1991 and have since been modified. Included in these criteria is a ferritin level >500 mcg/L. Although not diagnostic, a high ferritin level is highly suggestive of HLH. Serum ferritin assays are more accessible and cost-effective compared with other biochemical markers, particularly in resource-limited settings. Fifteen patients with HLH were treated at Red Cross War Memorial Children's Hospital between 1991 and 2010. Hyperferritinemia was a consistently reliable finding (93%) compared with either serum fibrinogen or triglycerides, which were elevated in only half of the patients. It is our contention that analysis of a complete blood count and serum ferritin (in addition to clinical criteria and tissue examination of marrow and/or cerebrospinal fluid) is probably the single most cost-effective and clinically helpful means to make the diagnosis of HLH when laboratory access is limited.

MeSH terms

  • Biomarkers / blood*
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis*
  • Developing Countries
  • Female
  • Ferritins / blood*
  • Humans
  • Infant
  • Lymphohistiocytosis, Hemophagocytic / blood
  • Lymphohistiocytosis, Hemophagocytic / diagnosis*
  • Lymphohistiocytosis, Hemophagocytic / economics*
  • Male
  • South Africa


  • Biomarkers
  • Ferritins