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. 2009 Aug;62(8):685-9.
doi: 10.1136/jcp.2009.064451.

Improved method for assessing iron stores in the bone marrow

K S Phiri  1 , J C J Calis, D Kachala, E Borgstein, J Waluza, I Bates, B Brabin, M Boele van Hensbroek
Affiliations

Improved method for assessing iron stores in the bone marrow

K S Phiri et al. J Clin Pathol. 2009 Aug.

Abstract

Background: Bone marrow iron microscopy has been the "gold standard" method of assessing iron deficiency. However, the commonly used method of grading marrow iron remains highly subjective.

Aim: To improve the bone marrow grading method by developing a detailed protocol that assesses iron in fragments, in macrophages around fragments and in erythroblasts.

Methods: A descriptive study of marrow aspirates of 303 children (aged 6-60 months) with severe anaemia and 22 controls (children undergoing elective surgery) was conducted at hospitals in southern Malawi (2002-04).

Results: Using an intensive marrow iron grading method, 22% and 39% of cases and controls had deficient iron stores, and 40% and 46% had functional iron deficiency, respectively. Further evaluation of the iron status classification by the intensive method showed that functional iron deficiency was associated with significantly increased C-reactive protein concentrations (126.7 (85.6) mg/l), and iron stores deficiency with significantly increased soluble transferrin receptor concentrations (21.7 (12.5) mug/ml).

Conclusions: Iron assessment can be greatly improved by a more intense marrow examination. This provides a useful iron status classification which is of particular importance in areas where there is a high rate of inflammatory conditions.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Bone marrow fragment showing iron deposits at ×400 magnification (top), and ×1000 magnification showing erythroblasts, iron and malaria pigment within macrophages (bottom).
Figure 2
Figure 2
Flow chart showing the number of children recruited and the number of bone marrow samples finally assessed using both Gale’s and intensive histological grading methods.
Figure 3
Figure 3
Error bar graphs for mean log ferritin, soluble transferrin receptor (sTfR) and C-reactive protein (CRP) concentrations for the different iron status classes using the intensive grading method.
See this image and copyright information in PMC

References

    1. Roy CN, Andrews NC. Anemia of inflammation: the hepcidin link. Curr Opin Hematol 2005;12:107–11 - PubMed
    1. Trey JE, Kushner I. The acute phase response and the hematopoietic system: the role of cytokines. Crit Rev Oncol Hematol 1995;21:1–18 - PubMed
    1. Helliwell T, Kelly S, Walsh H, et al. Elemental analysis of femoral bone from patients with fractured neck of femur or osteoarthrosis. Bone 1996;18:151–7 - PubMed
    1. van Dieijen-Visser MP, Marell GJ, Coenen JL, et al. Quantitative determination of non-haem iron and ferritin iron in bone marrow using flameless atomic absorption spectrophotometry. A comparative study on the cytological and chemical determination of the bone marrow iron content. Eur J Clin Chem Clin Biochem 1991;29:381–4 - PubMed
    1. Burns E, Goldberg S, Lawrence C, et al. Clinical utility of serum tests for iron deficiency in hospitalized patients. Am J Clin Pathol 1990;93:240–5 - PubMed

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