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Are routine iron stains on bone marrow trephine biopsy specimens necessary?
S E Stuart-Smith1, D A Hughes, B J Bain
1Department of Haematology, St Mary's Hospital, Praed Street, London W2 1NY, UK. sarass@tinyworld.co.uk
Aims:
To determine the role of Perls' staining in bone marrow trephine biopsy sections.
Methods:
The haemosiderin content of 155 Perls' stained, formic acid decalcified trephine biopsy sections was assessed and compared with Perls' stained aspirate samples in 105 cases and haematoxylin and eosin (H&E) stained biopsy sections in all cases.
Results:
An evaluable aspirate film with positive iron or at least seven negative particles was available for 105 biopsies. Only 71 of 95 cases with detectable aspirate iron had haemosiderin detectable on a Perls' stained section. None of 10 samples with a negative aspirate had a positive trephine biopsy. Haemosiderin was positive in 101 of the 155 Perls' stained sections, and was detectable on the H&E stained section in 71 of these cases. In five of 54 cases with negative Perls' staining, a small amount of haemosiderin was thought to be present on H&E staining.
Conclusions:
Aspirate smears reflect bone marrow iron stores more reliably than formic acid decalcified trephine biopsy sections. The presence of iron in Perls' stained aspirates in 44% of cases with negative Perls' stained sections indicates that iron is often lost from sections during decalcification. However, 61% of cases with unassessable aspirate samples had a positive trephine biopsy Perls' stain, contributing useful clinical information about iron status. Preparation of Perls' stained sections only in cases in which aspirate samples are inadequate for iron assessment and no obvious haemosiderin is present in an H&E stained section could produce savings in staff time and reagent costs.
Insights
Bone marrow aspirate smears are more reliable for assessing iron stores than Perls' stained trephine biopsy sections. Iron is often lost during decalcification, making aspirates a better diagnostic tool for iron status.
Area of Science:
- Hematology
- Histopathology
Background:
- Assessing bone marrow iron stores is crucial for diagnosing various hematological conditions.
- Perls' staining is a common method for visualizing iron in tissue samples.
Purpose of the Study:
- To evaluate the diagnostic utility of Perls' staining in bone marrow trephine biopsy sections for assessing iron stores.
- To compare the reliability of Perls' staining in trephine biopsy sections versus bone marrow aspirate smears.
Main Methods:
- 155 Perls' stained, formic acid-decalcified trephine biopsy sections were analyzed for haemosiderin content.
- Results were compared with Perls' stained aspirate samples (105 cases) and H&E stained biopsy sections (all cases).
Main Results:
- Bone marrow aspirate smears demonstrated higher reliability in reflecting iron stores compared to trephine biopsy sections.
- Iron was lost from trephine biopsy sections during decalcification in 44% of cases where aspirates showed positive iron.
- Perls' staining of trephine biopsies provided useful iron status information in 61% of cases with unassessable aspirates.
Conclusions:
- Bone marrow aspirate smears are superior to formic acid-decalcified trephine biopsy sections for assessing iron stores.
- Selective use of Perls' staining on trephine biopsies, when aspirates are inadequate and H&E shows no iron, can optimize resource utilization.
