Bableshwar Rajeshwari S, Roy Maitrayee, Bali Akshay, Patil Prakash V, Inumella Suvarna
Department of Pathology, KLE University's Jawaharlal Nehru Medical College, Belgaum, India.
Indian J Pathol Microbiol. 2013 Jan-Mar;56(1):16-9. doi: 10.4103/0377-4929.116142.
The increasing prevalence of multiple co-morbidities among anemic patients with chronic diseases have made the use of serum ferritin (which is also an acute phase reactant) and transferrin saturation more challenging in diagnosing iron deficiency. Microscopic examination of bone marrow aspirate is the gold standard" for assessing marrow iron store. However, conventional Gale's method assesses iron in marrow fragments alone which provides little valuable information about functional iron deficiency seen in many chronic diseases.
To perform an intensive bone marrow iron grading by assessing iron in fragments, in macrophages around fragments and in erythroblasts and to correlate the marrow iron store results with serum ferritin.
A descriptive study of Perl's Prussian blue stained bone marrow aspirate smears of 80 adult patients with moderate to severe anemia. Bone marrow iron was assessed by both the Gale's method and the intensive method and correlated with serum ferritin.
The intensive grading system revealed normal iron stores in 37.5% cases, depleted iron stores in 16.25% patients while 23.75% and 22.5% patients had functional iron deficiency and combined deficiency, respectively. Mean log ferritin concentration was significantly lower in patients with depleted iron stores (0.91 μg/l) in comparison to those with normal iron stores (2.13 μg/l; P = 0.001), functional iron deficiency (2.65 μg/l; P = 0.000), or combined deficiency (2.04 μg/l; P = 0.002).
Intense marrow iron examination provides a useful iron status classification which is of particular importance in cases of chronic diseases and inflammation.
慢性病贫血患者中多种合并症的患病率不断上升，这使得在诊断缺铁时使用血清铁蛋白（它也是一种急性期反应物）和转铁蛋白饱和度变得更具挑战性。骨髓穿刺涂片的显微镜检查是评估骨髓铁储存的“金标准”。然而，传统的盖尔方法仅评估骨髓碎片中的铁，这对于许多慢性病中所见的功能性缺铁几乎没有提供有价值的信息。
通过评估碎片、碎片周围巨噬细胞和成红细胞中的铁来进行强化骨髓铁分级，并将骨髓铁储存结果与血清铁蛋白相关联。
对80例中度至重度贫血成年患者的Perl普鲁士蓝染色骨髓穿刺涂片进行描述性研究。采用盖尔方法和强化方法评估骨髓铁，并与血清铁蛋白相关联。
强化分级系统显示，37.5%的病例铁储存正常，16.25%的患者铁储存耗尽，而23.75%和22.5%的患者分别存在功能性缺铁和混合性缺铁。与铁储存正常的患者（2.13μg/l；P = 0.001）、功能性缺铁的患者（2.65μg/l；P = 0.000）或混合性缺铁的患者（2.04μg/l；P = 0.002）相比，铁储存耗尽的患者平均对数铁蛋白浓度显著更低（0.91μg/l）。
强化骨髓铁检查提供了一种有用的铁状态分类，这在慢性病和炎症病例中尤为重要。
