scholarly journals Bone Marrow Iron Staining is a Reliable Test for Elimination of Iron Deficiency Anemia Rather than its Diagnosis.

2013 ◽  
Vol 23 (4) ◽  
pp. 260-263
Author(s):  
Ebru Koca
2021 ◽  
Author(s):  
Jiang-qiong Ke ◽  
Huicong Huang ◽  
Guangyao Zhou ◽  
Yan Li ◽  
Shengmin Shao ◽  
...  

Abstract Background: Hookworm disease discovered in a patient presenting with cerebral infarction due to severe iron-deficiency anemia and confirmed by gastroduodenoscopy has not been reported especially with negative stool routine. Case presentation: We report a male patient who presented himself to us with acute cerebral stroke verified as hookworm disease. Routine laboratory tests revealed low Hemoglobin (Hb) concentration but stool routine and occult blood test were normal. Brain magnetic resonance imaging (MRI) showed left-sided parietal-occipital lobe and centrum semiovale (“watershed”) infarction verified the diagnosis of acute ischemic stroke. Bone marrow aspiration showed proliferative bone marrow image with obvious red system hyperplasia. Gastroduodenoscopy discovered adult hematophagic hookworms in the bulb and descending part of duodenum of the patient. A series of conservative drug treatment was initiated and the patient was subsequently treated with albendazole after the gastroduodenoscopy. Twenty-five days later, the patient's physical function improved gradually and he was discharged without neurological deficit. Conclusion: Hookworm disease could be manifest in acute ischemic stroke. It was concluded that patients with severe iron-deficiency anemia should also be examined for rare intestinal parasitic diseases. Screening for these intestinal parasitic diseases in patients presenting with cerebral infarction and anemia could effectively avoid misdiagnosis and make increase the efficacy of treatment.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 953-953
Author(s):  
Jessica Garcia ◽  
Peggy Mankin ◽  
Pedro De Alarcon

Abstract Iron deficiency Anemia (IDA) induced reactive thrombocytosis occurs in children. The mechanisms involved in this phenomenon are indeterminate. Traditional cytokines involved in megakaryopoiesis such as Thrombopoietin (TPO), IL-6, and IL-11 have not been shown to be associated with this IDA induced thrombocytosis. Recent studies suggest that growth factors and signaling molecules involved in angiogenesis influence the proliferation and/or differentiation of megakaryocytes. A recent study observed that VEGFR1-mediated pathway up-regulates CXCR4 on megakaryocytes, leading to enhanced platelet production via distribution of megakaryocytes. We previously reported a statistically increased serum/plasma levels of FLT-3 and PDGF, but did not find an increase in plasma levels of TPO, VEGF and CXCR4 in an experimentally induced IDA in rats, when compared to control rats. We now present the histological evaluation of megakaryocytes and the expression of angiogenic signaling molecules, VEGF and CXCR4, in bone marrows of control and IDA rats. Six week old male Sprague-Dawley rats with jugular vein cannulas were obtained. Diet for control rats (N=9) and iron deficient diet rats (N=18) had 50 ppm and 7-8 ppm iron in Purina chow respectively. CBC, Iron Panel, and cytokines were drawn at baseline and five weeks later. On day 0, 1.5 mL of blood was drawn from iron deficient diet rats to further induce anemia. Rats were euthanized by CO2 asphyxiation and cardiac puncture. Femurs were collected, decalcified, and embedded in paraffin. Thin sliced sections were obtained to make slides. The slides were stained with hematoxylin and eosin (H&E), and with peroxidase linked anti factor VIII, VEGF, and CXCR4 according to manufacturer's instructions. The slides were evaluated under 40x microscopy. An area of 0.1 mm2 was selected and the numbers of megakaryocytes in the selected area were visually quantitated. Immunoperoxidase stained slides were analyzed using Image J software. When reviewing H&E stained bone marrow slides per 0.1 mm2, control rats contained 4 megakaryocytes, while those from IDA rats contained 11 megakaryocytes (P=0.0001). In Factor VIII stained slides, quantitative analysis of peroxidase stained megakaryocytes in control group contained 49,271 pixels, while staining in the IDA rats was 185,076 pixels (P=0.00002). When the analysis was carried out looking at vessel staining, there was a significant difference between controls (3.6) and IDA (8.5) per 0.1 mm2 (P=0.00001). In the VEGF stained slides, visual analysis of peroxidase stain showed increased intensity of staining per cell in the IDA rats. In the CXCR4 stained slides, visual inspection of the control bone marrows showed a rare small round cell weakly stained while these cells were more frequent and strongly stained in IDA rats. We successfully induced IDA in an animal model with coexisting thrombocytosis. Bone marrow slides in IDA rats documented the expected increase in number of megakaryocytes. In addition, we documented a marked increase in vascular structures of IDA rats. Contrary to our previously reported plasma levels, VEGF intensity of stain was greater within IDA rat megakaryocytes when compared to control rat megakaryocytes. We also documented an increase of CXCR4 in the bone marrows of IDA rats. However, this increase was limited to early stage megakaryocyte development cells suggesting a role during the differentiation process of megakaryocytes. Both our previous report on circulating angiogenic signaling molecules and the current histological data suggest an important role for angiogenesis in the development of IDA induced thrombocytosis. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
1981 ◽  
Vol 58 (6) ◽  
pp. 1164-1170 ◽  
Author(s):  
G de Klerk ◽  
PC Rosengarten ◽  
RJ Vet ◽  
R Goudsmit

Erythropoietin (ESF) titers were determined in sera from patients with different types of anemia using the fetal mouse liver cell bioassay. An inverse relationship was found between hemoglobin concentration and ESF titer. However, ESF titers differed markedly between patients at comparable degrees of anemia. Several groups of patients were distinguished on the basis of the activity of their erythroid bone marrow. In each of these groups, a significant negative correlation was found between the hemoglobin concentration and the logarithm of the ESF titer. ESF titers in patients with pure red cell aplasia were fourfold higher than those in patients with iron-deficiency anemia and tenfold higher than those in patients with megaloblastic anemia and homozygous sickle cell anemia at comparable hemoglobin concentrations. Following the initiation of specific therapy in patients with pernicious anemia and patients wit iron-deficiency anemia, serum ESF titers were found to decrease prior to any substantial rise in hemoglobin concentrations. In the patients with pernicious anemia, the lowest ESF levels were found 1 day after administration of vitamin B12, whereas in the patients with iron-deficiency anemia, the lowest ESF levels were reached in the second week of oral iron therapy. ON the basis of these data it was concluded that serum ESF titers in anemic patients are not only inversely related to the hemoglobin concentration but also to the activity of the erythroid bone marrow.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 39-40
Author(s):  
Hussam A Almasri ◽  
Ashraf Tawfiq Soliman ◽  
Vincenzo Desanctis ◽  
Arwa E Alsaud ◽  
Ruoa Alhashimy ◽  
...  

Introduction Iron deficiency anemia (IDA) is the most common cause of anemia in both developed and developing countries, particularly affecting females in the child bearing age and children. The treatment of IDA is a major health goal, it consists of treating the underlying cause and iron supplements. Iron replacement comes in form of oral or intravenous, there are certain side effects of this therapy including constipation and allergy. Leukopenia as a side effect of iron therapy is under reported in the literature as only sporadic cases were prescribed. We conducted a study to clarify this issue and to check for its clinical significance. Objective: To assess the relationship between iron therapy (intravenous) and leukopenia, neutropenia or lymphocytopenia, and its impact on patient's clinical settings. Materials and Methods We retrospectively reviewed the electronic medical records of patients attended Haematology clinic for iron deficiency anemia and treated with intravenous iron (ferric carboxymaltose or iron saccharide) over 2 years in Hamad Medical Corporation, Doha/Qatar. Adult female patients with IDA cases who received IV iron were included. anemia due to other nutrients deficienciesa nd conditions (including other medications) that may alter WBCs count were excluded.Age, Ethnicity, BMI, Complete blood count and iron studies data were collected before and after treatment with IV iron therapy. Infection occurrence at the time of IDA and leukopenia, the use of antibiotics and infection related complications were also collected. Leukopenia was defined as WBCs count to be less than 4000/microlitre, Neutropenia as ANC less than 1500/microlitre and lymphocytopenia as lymphocytes less than 1000/mocrolitre. Statistical analysis was done using mean , SD and t test. Results After iron therapy, out of 1567 case of iron deficiency anemia, 30 cases (1.914%) have leukopenia,15 cases (0.957%) have neutropenia and 12 cases (0.765%) have lymphocytopenia. All had normal readings before treatment. 2 patients (6.66%) had infection, 1 had upper respiratory tract infection and 1 urinary tract infection, the latter was treated with antibiotics, none reported infection related complications Discussion Leukocytopenia is defined as low WBCs circulating in the blood and this can be caused by low neutrophils count, low lymphocytes count, other WBCs components or combined. Some previous reported cases generated the idea of a possible connection between iron supplement therapy and leukopenia, Brito-Babapulle et al reported a case of fatal bone marrow suppression linked to ferric carboxymaltose therapy in a patient with IDA. The pathophysiology is not well understood but thought to be a toxic effect of iron on bone marrow and it can affect all cell lineages. Our findings suggest possible iron replacement side effect as there was significant drop of the WBCs count after treating IDA patients with IV iron, however this association was not common. There was no life threatening or serious infections in the affected patients, which can suggest that most of these cases are mild and transient. More studies are needed to address this issue, particularly on larger scales. Patient education also may be appreciated before treatment with IV iron. Conclusions: Leukopenia in form of neutropenia or lymphocytopenia maybe a side effect of IV iron therapy. Clinical significance is limited in view of current literature further studies needed to elaborate more in this important adverse event. Disclosures No relevant conflicts of interest to declare.


2021 ◽  
Vol 71 (6) ◽  
pp. 1920-24
Author(s):  
Tayyaba Ashiq ◽  
Ammara Hafeez ◽  
Abdus Sattar ◽  
Nasiruddin . ◽  
Naureen Saeed ◽  
...  

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.


1979 ◽  
Vol 384 (3) ◽  
pp. 357-362 ◽  
Author(s):  
Norbert Buyssens ◽  
Maurits Weert ◽  
Nadia Bourgeois

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4863-4863
Author(s):  
Magdalena Czader ◽  
Mingsheng Wang ◽  
Larry D. Cripe ◽  
Liang Cheng ◽  
Attilio Orazi

Abstract The management of patients with low-risk myelodysplastic syndromes (LR-MDS) transitioned from supportive care to active therapeutic interventions focused on the improvement of hematopoiesis. Thus, it is now critical to early identify patients with this disorder for optimal management. The diagnosis of myelodysplastic syndrome is based on clinical data, morphologic features of the bone marrow and conventional cytogenetic analysis. However, the majority of patients with LR-MDS do not demonstrate abnormal marrow karyotypes. In addition, changes in bone marrow morphology similar to those seen in LR-MDS, i.e. mild dysplasia with no increase in blasts, occur in a variety of systemic illnesses. Thus, there is a need for more objective diagnostic methods. The detection of loss of heterozygosity (LOH) can be supportive of the diagnosis of MDS as it is widely accepted that genetic lesion(s), including loss of tumor suppressor genes, lead to clonal expansion of hematopoietic populations in myelodysplasia. Indeed, previous studies and our pilot series showed high incidence of allelic imbalance in MDS. However, there is no data on the baseline LOH in bone marrows of age-matched controls without primary bone marrow disorder. To further explore the utility of LOH analysis in refining the diagnosis of LR-MDS, we investigated the incidence of allelic imbalance in bone marrows of patients with iron-deficiency anemia. The LOH analysis was performed using DNA extracted from formalin-fixed, paraffin-embedded bone marrow clot sections. Unrelated non-neoplastic tissues from the same patients served as controls. The oligonucleotide primers were selected based on previously reported high frequency of involvement in MDS and AML (D1S450, D11S1363, IRF1, D11S1338 and WT1). Nineteen patients were included in the study [median age 71 years, range 38–81 years; 8 males; median hemoglobin and MCV of 9.4 g/dL and 86 fL (normal range 80–94 fL)]. All patients showed depleted iron stores on bone marrow aspirate smears. Review of bone marrow morphology and subsequent follow-up showed no evidence of primary bone marrow disorder. Karyotypes, available in 7 patients, were normal, with the exception of one case showing loss of chromosome Y. Ninety two percent of the samples were informative. The overall frequency of LOH for all loci was 16% (12–21%, Tab. 1). LOH was seen in 10 cases (1 locus involved in 6 cases, 2 loci affected in 4 patients). LOH was not seen at any loci in the control samples from 19 non-bone marrow tissues from the same patients. In conclusion, we demonstrated a significant rate of LOH in non-neoplastic bone marrow tissue. For selected loci, the frequency of LOH approximates the rate seen in MDS samples. However, in the contrary to MDS group, no more than two markers were involved in any one patient with iron-deficiency anemia. The use of LOH analysis in the diagnosis of MDS may require selection of the primers based upon the background frequency of LOH in normal populations. The detection of LOH at numerous loci (more than two), may still serve as a valuable ancillary diagnostic tool. A prospective study of larger series will be necessary to confirm these findings and to address their clinical and biological significance. Tab. 1 Overall frequency of LOH (%) at the studied loci in bone marrows with iron-deficiency. Samples IRF1 D11S1363 D1S450 D11S1338 WT1 *Data from 16 MDS cases (Modern Pathology2004;17 suppl 1:255A) Iron-deficiency anemia 12 18 21 16 12 MDS* 31 26 20 19 40


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5080-5080
Author(s):  
Elizabeth A Price ◽  
Renee Mehra ◽  
Stanley L. Schrier

Abstract Abstract 5080 BACKGROUND Anemia in the elderly is common, and associated with substantial morbidity and even mortality. Approximately one third of patients with anemia will have no discernable etiology for their anemia, that is, so-called unexplained or idiopathic anemia of aging. Prior reports have suggested that 5-15% of elderly patients with anemia will have an underlying myelodysplastic syndrome (MDS). The purpose of this study was to prospectively evaluate a cohort of elderly outpatients for underlying causes of anemia. METHODS Men and women 65 years and older with anemia as defined by World Health Organization (WHO) criteria and seen either at Stanford Hospital and Clinics (SHC) or VA Palo Alto Health Care Systems (VAPAHCS) underwent a comprehensive hematologic evaluation to determine the etiology of the anemia. Assessment included a complete blood count, red cell indices, review of the peripheral smear, and evaluation of iron and cobalamin status and renal function. Patients were categorized as having MDS if diagnosed by WHO criteria. If a bone marrow evaluation was not performed or was nondiagnostic, patients were categorized as “suspicious for MDS” if the MCV was > 100 fl without an alternate explanation, the platelet count was < 130 K/αL, the WBC was < 4 K/αL, or there was dysplasia on the peripheral smear. If no etiology was found, patients were categorized as having “unexplained anemia” of aging. RESULTS A total of 196 patients have enrolled, and 156 have completed their diagnostic evaluation to date. Of these 156, 52 (33%) had unexplained anemia, 33 (21%) were found to have anemia related to a definite or suspected underlying hematologic malignancy, 24 (15%) had anemia related to a nonhematologic malignancy, 20 (13%) had previously unrecognized iron deficiency anemia, and 8 (5%) had anemia due to renal insufficiency. Additional etiologies included anemia of chronic inflammation (5 patients), thalassemia (2 patients), alcohol abuse (1 patient), B12 deficiency (1 patient), hypogonadism (1 patient), other (2 patients). In 7 patients (4%) the evaluation was not complete. Of those categorized with anemia related to an underlying hematologic malignancy, 12 of 33 (36%) were given a formal diagnosis, including acute myeloid leukemia, chronic myelomonocytic leukemia, Waldenstrom's, and, in 8 patients, MDS. An additional 21 of 33 (64%) were categorized as being “suspicious for MDS”. One patient initially categorized as being “suspicious for MDS” developed worsening cytopenias and underwent bone marrow evaluation which confirmed the diagnosis of MDS. Those suspected but not confirmed to have MDS had a median WBC of 4.9 K/αL, median hemoglobin (hgb) of 10.8 g/dL, median platelets of 170 K/αL, median mean corpuscular volume (MCV) of 96 fL, and median red cell distribution width (RDW) of 14%. In comparison, those confirmed to have MDS had a similar median WBC of 5.3 K/αL, lower median hgb of 10.3 g/dL, similar median platelet count of 199 K/αL, higher median MCV of 106.3 fL,and broader median RDW of 17%. Of the 20 patients with iron deficiency anemia, the diagnosis was made by standard laboratory iron indices in 14 (70%), by response to iron supplementation in 3 (15%), and by bone marrow aspirate and clinical diagnosis, respectively, in 1 patient (5%) each. Six of the 20 (30%) patients normalized their hgb following iron repletion, 5(25%) increased the hgb by at least one g/dL but did not reach a normal hgb level, and in 9 (45%) this information was not available. DISCUSSION In our study of elderly community-dwelling patients referred to an outpatient hematology clinic, 8% of patients were formally diagnosed with an underlying hematologic malignancy, and 13% were suspected to have MDS based on a high MCV, dysplasia on the peripheral smear, or additional cytopenias. Thus, overall, 21% were likely to have an underlying hematologic malignancy. Of the patients suspected to have MDS, none required specific therapy. Thirteen percent of patients were diagnosed with iron deficiency anemia, primarily by iron indices. A high proportion (25%) of these patients did not normalize their hemoglobin with iron repletion, suggesting additional underlying disease processes. The clinical advantage of recognizing that iron deficiency has been corrected is that further potentially expensive and invasive evaluation such as additional endoscopy can be avoided. Disclosures Price: NIH: Research Funding. Mehra:NIH: Research Funding. Schrier:NIH: Research Funding.


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