Evidence That Stainable Bone Marrow Iron Following Parenteral Iron Therapy Does Not Correlate With Serum Iron Studies and May Not Represent Readily Available Storage Iron

Abstract

We recently reported that parenteral iron therapy is associated with a characteristic pattern of iron staining on bone marrow aspirate smears. We now present clinical information from 6 patients who received parenteral iron and, at one or more points in follow-up, were found to have low or borderline low serum ferritin levels and/or serum iron levels, even though marrow aspirate smears revealed abundant stainable iron in the pattern characteristic of prior parenteral iron therapy. We conclude that stainable iron seen in this pattern does not correlate with serum iron studies and may not represent functionally available storage iron. This pattern of iron staining should not be used as evidence to withhold further iron therapy in patients who otherwise continue to have features of iron deficiency anemia.

Empty iron stores in children and young adults—the diagnostic accuracy of MCV, MCH, and MCHC

“…At the moment, s‐ferritin is the single best test for diagnosing iron deficiency when iron content in bone marrow is used as a gold standard . Even bone marrow iron may not always reflect the storage iron . Anyway, s‐ferritin was the only gold standard that could be applied in this study.…”

Diagnosis and treatment of cancer‐related anemia

“…The end result of increased hepcidin activity is hypoferremia, low TSAT, and iron‐restricted erythropoiesis . These biochemical and cellular events explain the typical findings of iron‐stained bone marrow aspirates of cancer patients showing increased storage iron yet markedly reduced‐to‐absent stainable iron in erythroid precursors .…”

Iron status and choice of iron therapy during pregnancy: advantages and disadvantages

“…32 The examination of Prussian blue-stained bone marrow aspirate for the presence or absence of histiocytic iron granules has been considered the "gold standard" in evaluating iron-depleted states. 46 However, marrow examinations are expensive, uncomfortable, and has been largely superseded by non-invasive methods. 47 Erythrocyte zinc protoporphyrin (ZnPP) is a sensitive test to diagnose iron deficiency anemia.…”