How should stainable iron in bone marrow films be assessed?

Abstract

Aims: To identify how many particles should be examined to enable a confident assessment of the presence or absence of iron stores and the quantity of iron in a bone marrow aspirate to be made. Methods: One hundred and ninety consecutive bone marrow aspirate samples were stained with Perls' stain and the iron content of 10 consecutive particles was recorded. The first particle found to be positive and the particle that was most positive were also noted. Results: A minimum of seven particles must be examined to establish the absence of stainable iron. A minimum of nine particles must be reviewed to see the maximum iron stores in 100% of samples and therefore make a valid judgment of whether iron stores are reduced, normal, or increased. By these criteria, 46% of the samples tested here could not be optimally assessed for absence of iron or maximum iron stores. Conclusions: The sensitivity of examination of bone marrow aspirates for iron stores can be optimised by increasing the number of particles reviewed to seven or more. This may require the staining of additional slides.

Can the Response to Iron Therapy Be Predicted in Anemic Nondialysis Patients with Chronic Kidney Disease?

“…The assessment of bone marrow iron stores was made by a qualitative method on an aspirate, and a recent study that used a quantitative method proved a strong relationship between iron stores and ferritin in HD patients (33). To overcome these, not only macrophage iron was considered but also the sideroblasts, and a sufficient number of slides were examined (17). Moreover, relationships were found between iron stores and response.…”

“…Positive and negative controls were used for calibration. Additional slides from aspirate were prepared when necessary, and at least nine bone marrow particles were reviewed for a final diagnosis (17).…”

Clinical use of low haemoglobin density, transferrin saturation, bone marrow morphology, Perl's stain and other plasma markers in the identification of treatable anaemia presenting for cardiac surgery in a prospective cohort study

“…Samples stained with Wright–Giemsa were used for cytomorphological evaluation. Perl's-Prussian blue reaction was used to assess bone marrow iron stores as previously reported by Hughes et al ,16 staining enough bone marrow aspirate slides in order to assess iron stores in at least seven bone marrow particles. Iron stores were then reported according to the method of Rath et al 17…”

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

“…In a small study conducted in 73% of the advanced HF patients with anemia and normal serum iron, ferritin, and erythropoietin levels, iron deficiency has been demonstrated in the bone marrow (220). Serum ferritin levels are low in only a small number of HF patients with iron deficiency (221). It can be explained with the fact that iron is not sufficiently presented to the bone marrow in HF, hence accumulates in the reticuloendothelial system and although iron and ferritin levels in blood are in normal or high levels, iron deficiency is observed more frequently in patients with HF accompanied by anemia.…”