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What is Bone marrow iron stain? 

Bone marrow is a spongy tissue present in the centre of some large bones in our body, like the pelvis, thigh bone, breast bone and backbone. It contains immature cells called stem cells, which develop into specialised blood cells, namely the white blood cells, red blood cells and platelets.

Our bone marrow also contains iron stores in the form of ferritin (an iron-containing protein in blood). Iron is an essential nutrient required for the production of red blood cells and the formation of haemoglobin (the oxygen-carrying blood protein).

Bone marrow iron stain is used to check the iron reserves in your bone marrow for the presence of conditions such as anaemia or iron overload. Perls’ Prussian blue is the stain used in this test. Under the microscope, it shows iron accumulation in shades of blue.

  1. Why is a Bone marrow iron stain performed?
  2. How do you prepare for Bone marrow iron stain?
  3. How is Bone marrow iron stain performed?
  4. What do Bone marrow iron stain results mean?

Your doctor may ask you to get this test if he/she suspects that you have symptoms of iron deficiency. Some common symptoms and signs of iron deficiency anaemia are:

Iron stain also helps the doctor to detect an increase or decrease in the proportion of sideroblasts (immature red blood cells) in the bone marrow. This test is helpful in the diagnosis of sideroblastic anaemias, a group of blood disorders in which, despite having sufficient iron, the body is unable to use it for making haemoglobin. This results in the accumulation of iron in the sideroblasts, giving them an abnormal ringed appearance.

Inform your doctor if you are taking any medications or health supplements. Your doctor may ask you to discontinue medicines like blood thinners before the test. Do not stop using any medication on your own.

In case you have previously had an adverse reaction to anaesthetics, you must communicate this with your doctor before the test. 

If you are anxious about the procedure, your doctor may give you a sedative beforehand to help you feel relaxed. If you are going to be sedated, you will be asked to refrain from eating or drinking anything for some time before the procedure.

The test requires a sample of your bone marrow, which will be obtained by bone marrow biopsy or by bone marrow aspiration. A bone marrow biopsy sample is likely to be collected from your hip bone. The procedure can take up to 15 minutes or more. Here is how a bone marrow biopsy done:

  • You will be asked to lie down on your side and pull up your knees close to your chest. During the biopsy procedure, you will be required to remain as still as possible. 
  • Your doctor will clean an area overlying the hip bone using an antiseptic solution.
  • He/she will then inject a local anaesthetic to numb the area. 
  • When the area becomes numb, a special needle will be injected into the space in the middle of the bone to draw out a sample of bone marrow fluid. The fluid is drawn using this needle.
  • A second needle will be used to remove a sample of the harder bone tissue.
  • The needle will be removed and a dressing will be put over the site of needle insertion. This dressing must not be removed for at least 24 hours or until the bleeding (if any) has stopped. 
  • After the biopsy is done, you will be asked to continue lying down for at least 15-30 minutes to make sure that there is no bleeding. 

If you were given a sedative, you may feel a bit drowsy for a few hours after the biopsy. In such a case, do not drive home on your own or operate any machinery that day. 

The local anaesthetic injected during the biopsy will wear off after a few hours. Because of this, the area may feel sore again. To manage the pain, you can take pain-relief medications for a few days after consulting the doctor. 

Some of the risk factors associated with bone marrow biopsy are:

  • Persistent pain after the procedure 
  • Bleeding
  • Infection 

You must consult your doctor immediately if you have symptoms of infection, such as fever or increasing pain, redness or swelling at the puncture site.

Normal results:

Results will be interpreted according to the iron storage identified on staining. Normal results indicate that the given bone marrow sample contains normal number of cells and tissue.

Abnormal results:

Low iron stores indicate conditions such as iron deficiency anaemia, while high iron stores are seen in conditions such as megaloblastic anaemia and sideroblastic anaemia. Sideroblastic anaemia is characterised by the presence of ringed sideroblasts (immature red blood cells with an excess of iron) in the bone marrow.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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  1. Lymphoma Action [Internet]. U.K., Bone marrow biopsy
  2. MDS Foundation [Internet]. What Does My Bone Marrow Do?
  3. Arpana Dharwadkar et al. Study of sideroblasts and iron stores in bone marrow aspirates using Perls' stain. Medical Journal of Dr. D.Y. Patil Vidyapeeth. Volume 9. Issue 2. Page: 181-185.
  4. American Society of hematology [internet]; Iron-Deficiency Anemia
  5. National Organisation of Rare Disorders [Internet]. Danbury, CT, U.S. Anemias, Sideroblastic
  6. UFHealth [internet]: University of Florida; Bone marrow biopsy
  7. Mario Cazzola, Rosangela Invernizzi. Ring Sideroblasts And Sideroblastic Anemias. Haematologica June 2011 96: 789-792; Doi:10.3324/haematol.2011.044628
  8. Chernecky CC, Berger BJ. Bone marrow aspiration analysis-specimen (biopsy, bone marrow iron stain, iron stain, bone marrow). In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:628-629.
  9. Amer Wahed, Amitava Dasgupta. Chapter 3 - Red Blood Cell Disorders. Hematology and Coagulation. 2015, Pages 31-53.
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