Absence of stainable bone marrow iron in hemochromatosis

Stainable bone marrow iron was absent from two patients who were found at autopsy to have hemochromatosis. Bleeding could have accounted for the absence of marrow iron in one patient, but there was no evidence of blood loss in the other. Both had cirrhosis and heavy iron deposits in the liver parenchyma. It is suggested that in patients with hemochromatosis and hepatic cirrhosis, absorbed dietary iron is ultimately taken up by the liver at the expense of the erythron, resulting in gradual depletion of marrow stores. A postulated mechanism is that the shunting of portal blood around the liver circumvents some iron-liver interaction that directs absorbed dietary iron to the erythron.