Assessment of Bone Marrow Iron Stores using Gale's Grading and Its Correlation with Iron Deficiency Anemia

Abstract

Background: Iron deficiency anemia (IDA) is a very common condition worldwide, especially in low- and middle-income countries. The most accurate method to evaluate iron status is the measurement of bone marrow iron content by potassium ferrocyanide (Prussian blue)-stained aspirate. Microscopic examination of Prussian blue-stained bone marrow aspirate has been considered the “gold standard” for determining iron-depleted states. Aim: The aim of this study was to assess and classify the iron status in the bone marrow by both Gale's and intensive method, thereby differentiating iron store deficiency from functional deficiency. Methods: The present study was carried out in the Department of Pathology, Government Medical College and Hospital, Jammu, over a period of 1 year. A total of 135 cases of anemia with hemoglobin <10 g/dl were included in the study. Bone marrow aspiration was done; iron assessment was done by both Gale's and intensive method. Iron status assessed by the intensive method was categorized as normal, functional iron deficiency, iron stores deficiency, or combined functional iron and iron stores deficiency. Results: A total of 135 cases were included in the study, out of which 47% (64/135) were male and 53% (71/135) were female. Gale's study revealed hypoferrimic state in only 40 cases out of 135 (29.6%). According to the intensive method, out of these 40 cases, only nine cases were truly deficient cases that too had combined deficiency, two cases had iron store deficiency, 25 cases had functional iron deficiency, and four cases had normal iron stores. In the present study, according to the intensive method, maximum number of cases had functional iron deficiency (54%, 73/135). There were 1.4% (2/135) pure iron-deficient cases and 11.1% (15/135) revealed combined deficiency. Conclusion: Differentiation between IDA and functional iron deficiency is important for accurate diagnosis and treatment of the patient. Although intensive method of grading iron requires more expertise, it has proved to be superior and has more precision in diagnosing iron-deficient cases.