Evidence check: Ferritin Eisenmangel in the context of stress

Ferritin is an iron storage protein but also an acute-phase reactant that can rise during inflammation and stress. Therefore, a normal or even elevated ferritin level under chronic stress does not rule out functional iron deficiency – stress-induced inflammation can increase hepcidin, blocking iron absorption and recycling, leading to low available iron despite adequate stores. Evidence comes from human observational and mechanistic studies, but large-scale clinical trials are lacking. Additionally, cortisol may affect erythropoiesis. For accurate iron status assessment, combine ferritin with transferrin saturation, soluble transferrin receptor, and CRP. Interpreting ferritin alone in stressed individuals is misleading. Evidence: human-moderate (observational, mechanistic).