Assessment of iron status in cases of anemia: A comparative analysis by Gale’s and Intensive method.
Keywords:
Anemia, Bone marrow iron, Gale’s method, intensive method
Abstract
Background: Nutritional anemia particularly iron deficiency anemia comprise a major public health problem in India. Precise diagnosis is necessary for the correct treatment as the multiple coexisting morbid chronic inflammatory conditions seen in these cases gives erroneous biochemical results. Microscopic assessment of bone marrow iron is considered to be the the gold standard. However, the conventional Gale’s method cannot differentiate between the iron deficient cases and functional iron deficiency. This is made possible by the newer intensive method of iron assessment in the present study.Aim: To compare the assessment of iron status by Gale’s and Intensive method on bone marrow aspirate smears in cases of anemia.Materials and Methods: A prospective study of 117 cases of all age groups and both sexes, having haemoglobin < 10mg/dl were included in the study. Bone marrow aspiration was done and iron assessment was done by both the Gale’s and Intensive method. Serum ferritin was also done in 23 out of 117 cases to serve as a control. However, it was not a part of the study.Results: Gale’s method revealed hypoferrimic state in 29.1% cases and normal iron stores in 70.9% cases. Iron deficient status was further reduced to 6.83% cases by the intensive method of iron assessment. Maximum number of cases had functional iron deficiency by the intensive method.DOI:10.21276/APALM.1545References
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12. Roy CN, Andrews NC. Anemia of inflammation: hepcidin link. Curr Opin Hematol. 2005;12: 107-11.
13. Trey JE, Kushner I. The acute phase response and the hematopoietic system: the role of cytokines. Crit Rev Oncol Hematol 1995; 21: 1-18.
14. Wish JB. Assessing iron status: Beyond serum ferrtin and transferrin saturation. Clin J Am Soc Nephrol 2006; 1: 84-8.
15. Bableshwar RS, Roy M, Bali A, Patil V P, Inumella S. Intensive method of assessment and classification of bone marrow iron status: A study of 80 patients. Indian J of Pathol and Microbiol. 2013; 56(1) : 16-19.
2. NFHS India 2005-06, National Family Health Survey-III (NFHS –III). Anemia among women and children, Mumbai: International institute for population sciences 2006.
3. WHO. S. ferritin concentration for the assessment of iron status and iron deficiency in population. Vitamin and mineral nutrition information system. Geneva: World Health organisation; 2011.
4. Krause JR, Stole VS. Ferritin and bone marrow iron stores and correlation with absence of iron in biopsy specimens. Am J Clin Pathol 1979; 72: 817-20.
5. Baynes RD. Assessment of iron status. Clin Biochem. 1996; 29: 209-15
6. Hughes DA, Stuart - Smith SE, Bain BJ. How should stainable iron in bone marrow films be assessed? J Clin Pathol 2004; 57: 1038 -40.
7. Phiri KS, Calis JC, Kachala D, Borgstein E, Waluza J, Bates I et al. Improved method of assessing iron stores in bone marrow. J Clin Pathol 2009;6: 685-9.
8. Stuart–Smith SE, Hughes DA, Bain BJ. Are routine iron stains on bone marrow trephine biopsy specimen necessary? J. Clin Pathol 2005; 58: 269-72.
9. Gale E, Torrence J, Bothwell T. The quantitative estimation of total iron stores in human bone marrow. J Clin invest 1963; 42: 1076-82.
10. Johansson SV, Plantin LO, Strandberg PO, et al. Estimation of iron in human bone marrow with histological, chemical and neutron activation analysis. Clin Chem Acta 1970; 30: 549-58
11. Ebru K, Deniz A C, Yahya B, et al. Bone Marrow iron staining is a reliable test for elimination of iron deficiency anemia rather than its diagnosis. International J of Hematol and Oncology 2013;4: 23:260-3.
12. Roy CN, Andrews NC. Anemia of inflammation: hepcidin link. Curr Opin Hematol. 2005;12: 107-11.
13. Trey JE, Kushner I. The acute phase response and the hematopoietic system: the role of cytokines. Crit Rev Oncol Hematol 1995; 21: 1-18.
14. Wish JB. Assessing iron status: Beyond serum ferrtin and transferrin saturation. Clin J Am Soc Nephrol 2006; 1: 84-8.
15. Bableshwar RS, Roy M, Bali A, Patil V P, Inumella S. Intensive method of assessment and classification of bone marrow iron status: A study of 80 patients. Indian J of Pathol and Microbiol. 2013; 56(1) : 16-19.
Published
2018-02-27
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