Sideroblastic Changes Can Be Recognized in the Erythrogram.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4909-4909
Author(s):  
Alicia Rovó ◽  
Jakob R. Passweg ◽  
Geneviève Favre ◽  
Dominik Heim ◽  
Sandrine Meyer-Monard ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Predictive Value ◽  
Statistical Significance ◽  
Diagnostic Approach ◽  
Distribution Width ◽  
Rbc Indices ◽  
Scatter Plots ◽  
Bone Marrow Iron ◽  
Cell Counter

Abstract The scatter plots of red blood cells (RBC), called erythrogram produced by the ADVIA® 2120 cell counter gives a visual representation of RBC characteristics. Using a pair of threshold gates on each axis, nine areas are defined according to the cell volume and the hemoglobin (Hb) content. Normal RBC are distributed in the central quadrant. In diseases such as iron deficiency and thalassemia the erythrogram shows a characteristic pattern commonly used for diagnostic approach. We observed in patients, mainly with myeloid diseases with ringed sideroblasts (RS) in the bone marrow a particular erythrogram pattern with a broad distribution of the RBC and a marked variation in RBC size and hemoglobinization. From the central quadrant an abnormal RBC population shifts on an imaginary axis to the lower-left quadrant representing a tail advancing into the microcytic and hypochromic quadrants (Fig1). To confirm whether this particular erythrogram was predictive for bone marrow sideroblastic changes; we compared retrospectively the erythrogram of patients with RS to a group of myeloid diseases without RS. Between January 2004 and August 2005, 33 of 1973 cases with more than 15% of RS in the marrow were identified, 21/33 patients were evaluable (AML=2, MDS=13, MPS=1, MDS/MPS=3, non neoplasia=2). These patients were compared to 30 consecutive cases with myeloid diseases without RS (No RS) (AML=16, MDS=11, MPS=2, MDS/MPS=1). In addition to the erythrogram pattern, Hb, RBC indices, and bone marrow iron staining were analyzed in both groups. We defined two types of erythrogram pattern in respect of sideroblastic changes: a) typical (fig1) b) non typical: any other pattern (i.e. macrocytosis, fig 2). The erythrogram was typical in 17/21 patients with RS and in 0/30 patients with No RS (p<0.0001). The positive predictive value for sideroblastic changes was 100% and the negative predictive value was 88%. Despite the RBC indices comparison showed statistical significance in some variables, they were not specific enough to identify sideroblastic changes. In the group with RS, mean cell Hb was lower (median 30.8 versus 33.6pg), RBC distribution width was higher (19.3 versus 16.5%), the % of hypochromic RBC was higher (5.3 versus 0.9%) and Hb content of reticulocyte was lower (33 versus 37 pg) compared to No RS patients (p<0.05). This last index was particularly useful to rule out iron deficiency in RS group as a cause of hypochromic RBC changes, since in contrast to iron deficiency it was not decreased. In conclusion: sideroblastic changes can be recognized in the erythrogram. Indeed, despite myeloid diseases with RS are a heterogeneous group of diseases they have a common pattern of RBC distribution that can be considered as a kind of fingerprinting for sideroblastic changes with a high predictive value allowing a straightforward diagnostic approach in clinical practice. Figure 1 Figure 1. Figure 2 Figure 2.

scholarly journals Differentiation of Beta Thalassemia Trait and Iron Deficiency Anaemia by Red Cell Indices

2019 ◽  
Vol 13 (2) ◽  
pp. 39-41
Author(s):  
Md Nurunnabi ◽  
Mosammath Khadiza Mamdu ◽  
Mohammad Maksudur Rahman ◽  
Farzana Zafreen ◽  
Md Abdul Wahab
Keyword(s):  
Iron Deficiency ◽  
Predictive Value ◽  
Iron Deficiency Anaemia ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Deficiency Anaemia ◽  
Rbc Indices ◽  
Automated Cell Counter ◽  
Cell Counter

Introduction: Beta thalassaemia trait (β-TT) and iron deficiency anaemia (IDA) are the most frequent causes of hypochromic microcytic anaemia in Bangladesh. Differentiation between βTT and IDA is important for proper treatment of patients. Red blood cell (RBC) indices obtained from automated cell counter can be used to differentiate between two. Objective: To compare among three RBC indices; red cell distribution width (RDW), red cell distribution width index (RDWI) and Mentzer’s index to differentiate between βTT and IDA. Materials and Methods: This cross-sectional comparative study was conducted on 50 diagnosed cases of β-TT and 50 cases of IDA at the department of pathology, BNS Patenga, Bangladesh from January 2016 to December 2017. Patients with Hb <6.0 gm/dl was excluded because below this level IDA and β-TT morphologically become very much distinguishable. RDW, RDWI and Mentzer’s index were calculated from the automated cell counter. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to compare diagnostic value of the indices. Results: Mentzer’s index was found the most reliable index as it had the highest sensitivity 95.1% and specificity 84.8% for detecting IDA. RDWI showed much lower sensitivity 91.2% and specificity 66.2% while RDW showed sensitivity and specificity of 83.2% and 61.1% respectively. Conclusion: Mentzer’s index is a reliable and useful index for differentiation between IDA and β-TT compared to other two indices. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 39-41

scholarly journals KEKURANGAN ZAT BESI DI PEREMPUAN HAMIL MENGGUNAKAN HEMOGLOBIN RETIKULOSIT (RET-HE)

2016 ◽  
Vol 19 (3) ◽  
pp. 156
Author(s):  
Petriana Primiastanti ◽  
Ninik Sukartini
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Transferrin Saturation ◽  
Stage I ◽  
Stage Ii ◽  
Bone Marrow Iron

Iron deficiency is the most common nutrional deficiency in the world, mostly in developing and industrial countries. Population with highest risk of iron deficiency generally are reproductive-age women. In Indonesia, the prevalence of iron deficiency anemia in pregnant women is about 50.5%. Anemia due to iron deficiency in pregnancy can affect both mother as well as the foetus. In order to prevent permanent systemic complication, it is important to do early detection before iron deficiency anaemia developes. In the early phase of iron deficiency prior to anaemia, additional tests of ferritin, serum iron and saturation index are needed besides the complete blood count. A new parameter named reticulocyte hemoglobin equivalent (RET-He) has been developed to detect the level of hemoglobin in an immature erythrocyte or reticulocyte. Reticulocytes will be present in the peripheral circulation for only 24−48 hours, so the RET-He will give more appropriate information about the condition of bone marrow iron. When the bone marrow iron is depleted, the RET-He will show a decrease. In several hematology analyzers, for example Advia 2120 and Sysmex XE 2100, this parameter can be tested together with CBC, so no additional blood sample is needed. The aim of this study is to know iron deficiency in healthy first and second trimester pregnant women by screening using RET-He and compare the result to other parameters that are now available, such as: hemoglobin, ferritin, transferrin saturation. Those parameters can develop RET-He cut-off with optimal sensitivity and specificity. The study comprised 100 healthy pregnant women from I and II trimester who did not develop anemia yet during their last pregnancy. The subjects were divided into three (3) groups based on ferritin and transferrin saturation: 67 women (67%) without iron deficiency, 17 women (17%) with iron deficiency stage I, and 16 women (16%) with iron deficiency stage II. Hemoglobin, RET-He, and transferrin saturation showed a mean±SD of 12.35±1.02 g/dL, 33.60±1.88 pg and 28.63±1.07%, respectively. Median ferritin (min-max) was 40.10 (6.24–191.30)ng/mL. By using receiver operating curve (ROC) in this study RET-He point was found at 33.65 pg as an optimal cut-off point to differentiate iron deficiency with sensitivity and specificity of 67% and 64.18% respectively. From cross tabs table of RET-He with ferritin as the gold standard and 33.65 pg as the cut-off point results were 47.8% positive predictive value (PPV), 79.6% negative predictive value (NPV), positive likelihood ratio (LR) 1.86 and negative likelihood ratio (LR) 0.52. In this study, significant differences between non iron deficiency and the iron deficiency stage II groups and between iron deficiency stage I and iron deficiency stage II groups were found. There was no difference between the non iron deficiency and iron deficiency stage I groups.

scholarly journals Role of intensive method of bone marrow iron assessment and serum Ferritin in prediction of iron deficiency: a study of 143 patients

2018 ◽  
Vol 5 (4) ◽  
pp. 686-691
Author(s):  
Mayank Singh ◽  
Swati Raj ◽  
Dwijendra Nath ◽  
Pallavi Agrawal ◽  
Sufiya Ahmed
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Serum Ferritin ◽  
Bone Marrow Iron

Lab Indicators of Iron Level in Bone Marrow Aspirate of Patients Diagnosed with Multiple Myeloma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5397-5397
Author(s):  
Ankit Mangla ◽  
Sriman Swarup ◽  
Muhammad Umair Mushtaq ◽  
Hussein Hamad ◽  
Sharad Khurana ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Iron Deficiency ◽  
Bone Marrow Aspirate ◽  
Binding Capacity ◽  
Iron Level ◽  
Iron Binding ◽  
Iron Stores ◽  
Bone Marrow Iron ◽  
Iron Binding Capacity

Abstract Introduction Iron plays a critical role in patients with multiple myeloma (MM). The limited availability of iron to the developing erythroid precursors results in the characteristic anemia so frequently seen in these patients. Moreover, iron is also a determinant in growth of the malignant plasma cells that makes it one of the critical factors in progression of the disease. Iron is a key component in success of erythropoietin (EPO) therapy that is often used to maintain hemoglobin (Hb) level of >10g/dL in patients with MM. International Myeloma working group (2011) advised transfusing IV iron to aid in success of EPO therapy. However, apart from determining the iron stores on bone marraow aspirate, there is hardly any reliable clinical or lab indicator of the iron stores in the body. The utility of various iron indices in determining the bone marrow iron stores remains anecdotal. In this study we aim to determine the relation between iron indices and iron level in the bone marrow of patients diagnosed with multiple myeloma. Methods A total of 268 multiple myeloma patients, diagnosed from 2004 to 2015, were identified from tumor registry of John H. Stroger Jr. Hospital of Cook County, Chicago. Accuracy of ferritin, iron level, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC) and transferrin saturation (TSAT) was evaluated using receiver operating characteristic curves (ROC). Out of sampled patients, 167 patients had a concurrent bone marrow biopsy and aspirate, serum ferritin and iron panel, and were included in ROC analyses. Results The study population consisted of 57% African-Americans, 18% Caucasians and 16% Hispanics. Median age was 61 years and 51% were females. Past history was significant for hypertension (48%), diabetes (31%), co-existing inflammatory conditions (18%), smoking (25%), alcohol abuse (17%) and illicit drug abuse (8%). Median hemoglobin, mean corpuscular volume (MCV), leukocytes and platelets were 10g/dL, 90.3fL, 6,200/mcL and 219,500/mcL respectively. Bone marrow aspirates for iron were rated as absent (37%), mild/moderate (18%) and adequate/normal (45%). Anemia was found in 79% of males (Hb <12.9g/dL) and 76% of females (Hb<11.7 g/dL). Of the patients with anemia, 36% of males and 39% of females had absent iron stores (determined by prussian blue staining method) on bone marrow aspirate. MCV was not significantly related with iron deficiency. Iron level, TIBC, UIBC and TSAT were not significantly associated with bone marrow iron (P>0.05). Only ferritin was significant predictor of iron deficiency and presence of iron in bone marrow (AUC 0.64, 95%CI 0.55-0.74, P=0.002). Ferritin levels of ≤15mcg/L (positive LR 3.77, sensitivity 3.4%, specificity 99.1%), ≤30mcg/L (positive LR 2.59, sensitivity 11.9%, specificity 95.4%) and ≤50mcg/L (positive LR 4.35, sensitivity 32.2%, specificity 92.6%) predicted iron deficiency. Ferritin levels of ≥100mcg/L (positive LR 1.47, sensitivity 76.9%, specificity 47.5%), ≥200mcg/L (positive LR 1.46, sensitivity 54.6%, specificity 62.7%) and ≥500mcg/L (positive LR 1.94, sensitivity 23.1%, specificity 88.1%) ruled out iron deficiency. Conclusion Of all the indices predicting iron deficiency, only ferritin was significantly associated with absent iron in bone marrow aspirates. In MM patients, iron supplementation should be considered with ferritin levels of ≤50mcg/L and can be deferred with ferritin levels of ≥500mcg/L. Further studies are needed to explore the association. Disclosures No relevant conflicts of interest to declare.

scholarly journals DIAGNOSTIC ACCURACY OF SERUM FERRITIN AND SOLUBLE SERUM TRANSFERRIN RECEPTOR, TAKING BONE MARROW IRON STAIN AS A GOLD STANDARD FOR IRON DEFICIENCY ANEMIA IN HETEROGENOUS GROUP OF PATIENTS

2021 ◽  
Vol 71 (6) ◽  
pp. 1920-24
Author(s):  
Tayyaba Ashiq ◽  
Ammara Hafeez ◽  
Abdus Sattar ◽  
Nasiruddin . ◽  
Naureen Saeed ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Diagnostic Accuracy ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Gold Standard ◽  
Bone Marrow Examination ◽  
Deficiency Anemia ◽  
Serum Transferrin Receptor ◽  
Bone Marrow Iron

Objective: To determine the diagnostic accuracy of serum ferritin and soluble serum transferrin receptor (sTfR), taking bone marrow iron stain as a gold standard for iron deficiency anaemia in heterogeneous group of patients. Study Design: Cross-sectional diagnostic accuracy study. Place and Duration of Study: Department of Diagnostic, Combined Military Hospital Lahore, from Mar to Aug 2020. Methodology: A total of 55 adult patients, of both genders, undergoing bone marrow examination for any reason were enrolled. Patients with known hemolytic condition (sickle cell anemia, megaloblastic anemia), taking erythropoietin/iron supplements, transfused red cell concentrate (RCC) recently or undergoing chemotherapy were excluded. Age, gender, clinical history and results of bone marrow examination, complete blood count (CBC), serum Ferritin and C-reactive protein (CRP) were recorded. Results: Serum ferritin was found to be less sensitive (28%) but more specific (100%) for reflecting reduced bone marrow iron stores as compared to sTfR (sensitivity: 60%, specificity: 96.6%). sTfR had highest likelihood ratio (15) and diagnostic accuracy (80%). On Receiver Operator Characteristic (ROC) graph Transferrin index (AUC=0.908) showed maximum accuracy, followed by Ferritin (AUC=0.884) and sTfR (AUC=0.879). Conclusion: Serum soluble transferring receptor (sTfR) and transferrin index has advantage over serum ferritin alone in predicting the bone marrow iron stores and differentiating iron deficiency anemia from anemia of chronic disease.

scholarly journals Low Hepcidin Levels in Severely Anemic Malawian Children with High Incidence of Infectious Diseases and Bone Marrow Iron Deficiency

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e78964 ◽  
Author(s):  
Femkje A. M. Jonker ◽  
Job C. J. Calis ◽  
Kamija Phiri ◽  
Rob J. Kraaijenhagen ◽  
Bernard J. Brabin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Infectious Diseases ◽  
High Incidence ◽  
Bone Marrow Iron

Erythrocyte Protoporphyrin in the Detection of Iron Deficiency

1975 ◽  
Vol 21 (8) ◽  
pp. 1121-1127 ◽  
Author(s):  
Gordon D McLaren ◽  
John T Carpenter ◽  
Hipolito V Nino
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Prussian Blue ◽  
Blue Staining ◽  
Comparable Group ◽  
Iron Stores ◽  
Erythrocyte Protoporphyrin ◽  
Bone Marrow Iron ◽  
The Mean ◽  
Mean Concentration

Abstract Any decrease in the availability of iron for incorporation into the heme moieties of hemoglobin results in an increase in the erythrocyte protoporphyrin concentration. Our aim was to compare protoporphyrin concentrations, determined spectrophotometrically, with body iron stores, as assessed from the amount of iron demonstrable by Prussian blue staining of bone marrow aspirates. The mean protoporphyrin concentration (175 µg/dl) in the erythrocytes of a group of patients with markedly decreased stainable marrow iron or no iron Was Significantly Greater (P &lt; .001) than the mean concentration (76 µg/dl) in a comparable group with adequate bone marrow iron stores, except in the presence of certain interfering conditions. These results suggest that the erythrocyte protoporphyrin test may be a useful addition to the methods now available for assessing disorders of heme synthesis, the most common of which is iron deficiency.

Low-dose oral iron absorption test in anaemic patients with and without iron deficiency determined by bone marrow iron content

2009 ◽  
Vol 63 (2) ◽  
pp. 103-111 ◽  
Author(s):  
Nanna M. Jensen ◽  
Margrethe Brandsborg ◽  
Anne M. Boesen ◽  
Hans Yde ◽  
Jens F. Dahlerup
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Iron Content ◽  
Low Dose ◽  
Iron Absorption ◽  
Oral Iron ◽  
Absorption Test ◽  
Dose Oral ◽  
Bone Marrow Iron

Clinical utility of the reticulocyte hemoglobin content in the diagnosis of iron deficiency

Blood ◽  
2002 ◽  
Vol 99 (4) ◽  
pp. 1489-1491 ◽  
Author(s):  
Alan E. Mast ◽  
Morey A. Blinder ◽  
Qing Lu ◽  
Sherri Flax ◽  
Dennis J. Dietzen
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Clinical Utility ◽  
Transferrin Saturation ◽  
Bone Marrow Examination ◽  
Hemoglobin Content ◽  
Iron Deficient ◽  
Receiver Operator Curve Analysis ◽  
Bone Marrow Iron ◽  
Reticulocyte Hemoglobin Content

Determination of the reticulocyte hemoglobin content (CHr) provides an early measure of functional iron deficiency because reticulocytes are the earliest erythrocytes released into blood and circulate for only 1 to 2 days. The CHr in 78 patients undergoing bone marrow examination was measured to assess its clinical utility for the diagnosis of iron deficiency. Twenty-eight patients were iron deficient, based on the lack of stainable iron in the aspirate. The diagnostic power of CHr is limited in patients with high mean cellular volume (MCV) or red cell disorders such as thalassemia. However, when patients with MCV more than 100 fL are excluded, receiver operator curve analysis of CHr, ferritin, transferrin saturation, and MCV demonstrates that CHr has the highest overall sensitivity and specificity of these peripheral blood tests for predicting the absence of bone marrow iron stores.

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