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Bone marrow fragment showing iron deposits at ×400 magnification (top), and ×1000 magnification showing erythroblasts, iron and malaria pigment within macrophages (bottom).
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cpt-62-08-0685-f01: Bone marrow fragment showing iron deposits at ×400 magnification (top), and ×1000 magnification showing erythroblasts, iron and malaria pigment within macrophages (bottom).

Mentions: All marrow smears were then systematically assessed using an intensive histological grading method in which iron is assessed in three sites—the fragments (as in Gale’s method), macrophages and erythroblasts. Iron assessed in the fragments and macrophages represented iron stores while iron in the erythroblast represented utilisable iron. Additionally, 20 fields around and behind the fragments were examined at high power (×1000) and all macrophages in these fields were examined for the presence of iron (fig 1). At high power magnification (×1000), 100 erythroblasts were examined and the percentage containing iron granules in their cytoplasm (ie, sideroblasts) were enumerated. Erythroblast iron deficiency was defined when <30% of erythroblasts had visible iron granules.18

Improved method for assessing iron stores in the bone marrow

Phiri KS, Calis JC, Kachala D, Borgstein E, Waluza J, Bates I, Brabin B, van Hensbroek MB - J. Clin. Pathol. (2009)

Bottom Line: 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).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.

Affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, PO Box 30096, Blantyre 3, Malawi. kamijaphiri@gmail.com

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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