Untreated Iron Deficiency Research Articles

Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Children and Adolescents: Recommendations of the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Society of Neonatology, and the Polish Society of Family Medicine

Background/Objectives. Iron deficiency is one of the most common nutritional deficiencies worldwide and is the leading cause of anemia in the pediatric population (microcytic, hypochromic anemia due to iron deficiency). Moreover, untreated iron deficiency can lead to various systemic consequences and can disrupt the child’s development. Methods/Results. Therefore, a team of experts from the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Neonatology Society, and the Polish Society of Family Medicine, based on a review of the current literature, their own clinical experience, and critical discussion, has developed updated guidelines for the diagnosis, prevention, and treatment of iron deficiency in children from birth to 18 years of age. These recommendations apply to the general population and do not take into account the specifics of individual conditions and diseases.

Evaluating Hemoglobin Thresholds on the Basis of Sex: Preliminary Insights from a Systematic Review

Introduction: World Health Organization hemoglobin thresholds to define anemia are identical for males and females until menarche after which they diverge to 130 g/L and 120 g/L, respectively. There is increasing concern that sex-defined hemoglobin lower limits of normal (LLN) are predicated on sampling females with untreated iron deficiency given its extremely high prevalence and relative under-prioritization in medicine. Inclusion of women with iron deficiency would, in and of itself, result in inappropriately low LLN. We therefore conducted a systematic review to evaluate the published literature to date on sex-based hemoglobin reference intervals (RIs). Methods: A systematic review was conducted using a comprehensive search of MEDLINE, EMBASE, CINAHL and Web of Science from inception to November 2022. Two reviewers independently screened and performed data extraction. A third reviewer adjudicated decisions when a consensus could not be reached. We excluded studies that only evaluated hemoglobin RIs in a state of know disease (e.g. untreated iron deficiency, bone marrow pathology, inherited red blood cell disorders, chronic systemic diseases). A priori defined quality assessment of all manuscripts was performed and included the following criteria: the manner in which “health” was defined in the sampled population, whether there was adherence to Clinical and Laboratory Standards (CLSI) guidelines for RI establishment studies, methodological rigour applied and transparent reporting of results. Results: 6411 articles were identified for title/abstract review. 885 articles were selected for full-text analysis, of which 143 extractions have been completed. We report the results of this convenience sample of the first 143 articles. Sixty-two articles aimed to establish hemoglobin RIs or thresholds to define anemia. The remainder of the studies (n=81) were establishing a hemoglobin mean. 32/143 articles evaluated a female population only, 9/143 were male-only and 102/143 presented both. Of those that sought to establish a RI, 42/62 (67.8%) adhered to CLSI guidelines. 110/143 articles included people with known iron deficiency or were at risk of iron deficiency. Of the 82 articles that considered iron status in the study design, 57 used ferritin as the screening laboratory parameter with variation in the definition of a normal ferritin to exclude iron deficiency (21 articles used a ferritin LLN of 12.0 ug/L,15 used a LLN of 16.0 ug/L, 7 used a LLN between 16.0-30.0 ug/L, and 1 used a LLN of 50 ug/L). Conclusion: 77% of the sample of studies evaluated failed to explicitly exclude individuals with known iron deficiency or its risk factors when deriving their LLN. Moreover, in studies that considered iron status of the sampled population, the majority used a ferritin LLN below conventional standards to define iron deficiency. Based on our preliminary findings, we suspect we will identify an overwhelming lack of consideration of the potential for iron deficiency to be present in patients used to define the LLN despite its well-established impact on erythropoiesis and its extremely high prevalence, particularly in females of reproductive age. At the annual meeting we will present more complete results, including a further exploration of the impact of excluding individuals with or at risk of iron deficiency from the cohort used to establish the LLN.

Quantifying microcyte and macrocyte percentages in archived red blood cell volume histogram images.

We sought to quantify percentages of microcytes and macrocytes in archived automated hematology analyzer (AHA) red blood cell (RBC) volume histogram images. In preliminary studies, we demonstrated that an on-line application of Gauss' area formula (SketchAndCalc™) measured percentage areas of 20 segments under a computer-generated normal distribution curve (-3.0 standard deviations [SD] to +3.0 SD) with accuracy and precision (Pearson's correlation of measured areas with corresponding theoretical areas r [20] = 0.9962 [p < 0.0001]). Thus, we used SketchAndCalc™ to quantify percentages of microcytes (50-80 fL) and macrocytes (110-200 fL) in archived AHA histogram images in women with previously untreated iron-deficiency anemia (IDA) and previously untreated hemochromatosis. Median microcyte percentages in 13 women with IDA and 13 women with hemochromatosis were 63.6% (range 13.5-76.8) and 6.7% (range 3.4-24.8), respectively (p < 0.0001). Mean macrocyte percentages in women with IDA and hemochromatosis were 8.8% ± 6.1 SD and 33.8% ± 11.7 SD, respectively (p < 0.0001). Spearman's correlations of microcyte percentages with macrocyte percentages, mean corpuscular volume, and mean corpuscular hemoglobin in 26 women were rs [26] = -0.9485, rs [26] = -0.9641, and rs [26] = -0.9036, respectively (each p < 0.0001). This method of quantifying microcyte and macrocyte percentages could enable other studies of RBC volume subpopulations in archived AHA histogram images.

Budget Impact Analysis of Ferric Derisomaltose for the Treatment of Iron-Deficiency in Malaysia

Introduction: Untreated iron deficiency (ID) can lead to severe anaemia, requiring blood transfusion, or increased mortality risk. Globally intravenous (IV) iron is increasingly recognised as a recommended option for patients. This study aims to evaluate the budget impact associated with introducing a new intravenous (IV) iron, ferric derisomaltose (Monofer® [IIM]) as one of the treatment options for the management of ID in the Ministry of Health Malaysia (MOHM) setting. Methods: A 5-year budget impact model was developed from 2020 to 2024 for patients with ID that require a high iron dose (≥500 mg), using the perspective of MOHM. The model was built with four external medical specialists, each with experience and deep knowledge of ID management, to support estimations on the future development of iron use in Malaysia. Results: Compared to the current market mix with the existing IV iron products (i.e., iron sucrose and iron dextran), a cost-saving of MYR 53,910 could be achieved with the introduction of IIM in 2020. The uptake of IIM into MOHM over five years is estimated to lead to an overall budget saving of MYR 11,837,524 over a 5-year time horizon. Conclusion: The use of IIM in place of the current IV iron products in MOHM resulted in a significant cost saving by reducing the number of visits required to achieve the targeted iron dose and the shorter IV infusion time with IIM.

Iron Deficiency in Pregnancy: A Brief Review

This paper highlights iron deficiency anaemia in pregnancy; its prevalence, causes, screening, and management. Iron deficiency is a spectrum that ranges from iron depletion to iron deficiency anaemia. Iron deficiency is the most common and leading cause of anaemia in pregnancy both in developed and underdeveloped countries. The incidence of iron deficiency anaemia varies worldwide depending on differences in race, socioeconomic factors, nutritional status, health condition, and the frequency of parasitic illnesses. Untreated Iron deficiency has significant adverse foetal and maternal consequences. The management of iron deficiency anaemia includes education regarding dietary modification, specifically ways to enhance iron absorption and iron supplementation. Although oral supplementation is typically the mainstay of treatment, more severe cases of iron deficiency anaemia may require intravenous supplementation.

EFFECTIVENESS OF ZINC PROTOPORPHYRIN/HEME RATIO IN IDENTIFICATION OF IRON DEFICIENCY IN A GROUP OF PRESCHOOL AGED CHILDREN

Iron deficiency anemia (IDA) is the ultimate result of untreated iron deficiency. Zinc protoporphyrin (ZPP)/heme ratio levels are a direct marker of iron status in the bone marrow during erythropoiesis. We studied the value of this index in screening for iron depletion or for deficiency in children seen for routine examination in a community pediatric practice.

Assessment of Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio in Iron Deficiency Anemia

Background and Aim: The present study is undertaken to investigate and establish the alteration in the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in iron deficiency anemia patients and to elucidate the link between iron with immunity and hemostasis. Methods: Complete hemogram along with differential leucocyte count and platelet count was done in 100 untreated iron deficiency anemia patients, who are visiting/admitted to KIMS, OPD, Hubballi, using Automated analyzer (HP 120). Results: The results of the present study showed clearly that there is a significant increase (P<0.05) in neutrophil-lymphocyte ratio as well as platelet-lymphocyte ratio among moderate and severe anaemic patients compared to normal individuals. Moreover, this increase in the ratio is more evident as the severity of anemia is increased. Conclusion: The alteration in neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in these patients may be due to low levels of iron as iron has a vital role in proliferation of different blood cells, especially lymphocytes. Thus, the outcome of the present study may be suggestive of a probable link between iron and immunity.

A PROSPECTIVE STUDY ON RISK FACTORS OF IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN AND THEIR MANAGEMENT

Objective: Iron deficiency anemia during pregnancy leads to preterm birth, low birth weight and increases the incidence of postpartum hemorrhage (PPH) and the reason for the incidence of PPH is higher in India compared with the rest of the world. In this study, our main goal was to find out the risk factors and complications of iron deficiency anemia and their management in pregnant women.&#x0D; Methods: It is a prospective study done at Obstetrics and Gynecology Department in Government District Headquarters Hospital, Tiruppur. All subjects were analyzed in full detail and hemoglobin estimation was also done to the patients.&#x0D; Results: Study found that 52% shows moderate anemia followed by 30% mild and 18% severe, respectively. Risk factors are found in 55% cases. Study found an association between risk factors and severity of anemia.&#x0D; Conclusion: Iron deficiency anemia continues to be the commonest etiology of anemia in pregnancy. The prevalence of iron deficiency in a pregnant woman is amongst the highest in the world. Untreated iron deficiency has significant adverse feto-maternal consequences. Iron supplementation and antenatal care are the basic requirements to prevent anemia.

Iron Deficiency Anemia in Pregnancy: Novel Approaches for an Old Problem.

Iron needs increase exponentially during pregnancy to meet the increased demands of the fetoplacental unit, to expand maternal erythrocyte mass, and to compensate for iron loss at delivery. In more than 80% of countries in the world, the prevalence of anemia in pregnancy is > 20% and could be considered a major public health problem. The global prevalence of anemia in pregnancy is estimated to be approximately 41.8%. Undiagnosed and untreated iron deficiency anemia (IDA) can have a great impact on maternal and fetal health. Indeed, chronic iron deficiency can affect the general wellbeing of the mother and leads to fatigue and reduced working capacity. Given the significant adverse impact on maternal-fetal outcomes, early recognition and treatment of this clinical condition is fundamental. Therefore, the laboratory assays are recommended from the first trimester to evaluate the iron status. Oral iron supplementation is the first line of treatment in cases of mild anemia. However, considering the numerous gastrointestinal side effects that often lead to poor compliance, other therapeutic strategies should be evaluated. This review aims to provide an overview of the current evidence about the management of IDA in pregnancy and available treatment options.

Evaluation of the use of erythropoietin-stimulating agents in a hospital setting to assess the necessity of a protocol-driven anemia management service

Erythropoietin-stimulating agents (ESA) have revolutionized the management of anemia. However, these agents are not always utilized with proper monitoring parameters, which can present significant safety concerns, unwarranted drug expenditures, and decreased ESA efficacy. This retrospective study assessed the utilization of all ESAs in non–intensive care unit hospitalized patients at a large academic medical center from August 18, 2018, to August 31, 2018, using established guideline-based assessment criteria. Among the 167 doses of ESA evaluated, 86% (n = 144) were utilized in accordance with guideline-based assessment criteria regarding laboratory monitoring of iron studies. However, 24% (n = 40) of ESA doses were administered to patients with active, untreated iron deficiency at the time of administration. Although most ESA doses were utilized in accordance with the guideline-based criteria, interventions can be implemented to further improve anemia treatment. Implementing a protocol-driven anemia management service is one strategy that can improve patient care, advance patient safety, and be cost-beneficial.

Reactive thrombocytosis related cerebral venous thrombosis: A rare complication of untreated iron deficiency anemia (P5.3-015)

Reactive thrombocytosis related cerebral venous thrombosis: A rare complication of untreated iron deficiency anemia (P5.3-015)

Management of Iron Deficiency Anemia in Pregnancy in India.

Iron deficiency anemia (IDA) continues to be the commonest etiology of anemia in pregnancy. The prevalence of iron deficiency (ID) in pregnant Indian women is amongst the highest in the world. Untreated iron deficiency (ID) has significant adverse feto-maternal consequences. Plethora of investigations are available for diagnosis of IDA, each having specific advantages and disadvantages when used in the pregnancy setting. Therapy for ID includes dietary modification, oral iron supplementation, intravenous iron and blood transfusion. Newer parenteral iron preparations are safe and there is mounting evidence to suggest their use in frontline settings for pregnancy associated IDA in the second and third trimester. Through this review, we suggest an algorithm for diagnosis and treatment of IDA in pregnancy depending on the severity of anemia and period of gestation suited for widespread use in resource limited settings. Also, we recommend ways for increasing public awareness and tackling this health issue including the observance of "National Anemia Awareness and Treatment Day."

Cardiac remodeling in response to chronic iron deficiency: role of the erythropoietin receptor.

Anemia is a common comorbidity of patients with heart failure, and iron deficiency is known as one of the causes of anemia in heart failure. Recent studies have shown that iron deficiency alone, without overt anemia, is associated with poor outcomes in patients with heart failure. Thus, to minimize the mortality in patients with heart failure, it is important to understand the link between iron deficiency and cardiac function. Chronic untreated iron deficiency results in cardiac remodeling, and we have previously reported that erythropoietin (Epo) and cardiac Epo receptor (EpoR) signaling may be associated with its remodeling. However, the link between EpoR signaling and its remodeling remains to be elucidated. Herein, we investigated the role of EpoR signaling on cardiac remodeling in response to chronic iron deficiency. Wild-type mice and transgene-rescued EpoR-null mutant mice, which express EpoR only in the hematopoietic lineage (EpoR-restricted mice), were fed with either a normal or an iron-restricted diet, and the molecular mechanisms were investigated. Dietary iron restriction gradually induced anemia, Epo secretion, and cardiac hypertrophy in wild-type mice. In contrast, EpoR-restricted mice fed with an iron-restricted diet exhibited anemia, left ventricular dilatation, and cardiac dysfunction compared with wild-type mice. Interestingly, altered cardiac mitochondrial biogenesis was observed in EpoR-restricted mice following iron deficiency. Moreover, cardiac p53 expression was increased in EpoR-restricted mice compared with wild-type mice following iron deficiency. These data indicate that EpoR signaling is associated with cardiac remodeling following chronic iron deficiency.

HAEMATINIC ACTIVITY OF ECHURAMOOLI LEAF CHOORANAM IN PHENYLHYDRAZINE INDUCED ANAEMIC RATS

Iron deficiency is the most common and widespread nutritional disorder in the world. India is among the countries with highest prevalence of anaemia in the world. It has serious consequences for the health and well - being as well as social and economic impacts of India . Untreated iron deficiency anaemia can become severe enough to interfere with daily life. Knowledge of iron deficiency and its treatment in Siddha Sys tem of medicine dates back from time immortal. Many plants in Siddha system of medicine are known to have remarkable effects in treating anaemia . One such medicine is “ Echuramooli Leaf Chooranam ” Aristolochia indica Linn. The haematinic activity of Echuram ooli Leaf Chooranam was studied in Phenylhydrazine induced anaemic r ats. Anaemia was induced by an oral administration of Phenylhydrazine for a period of 7 days. The Echuramooli Leaf Chooranam was administered at the various dose levels of 50 mg/kg, 100 mg /kg and 2 00 mg/kg oral ly to the animals for 14 days. Hb concentration, RBC count, PC V, MCH, MCHC were analysed as indices of anaemia. Phenylhydrazine significantly decrease the haematological parameters. After 14 days of treatment with trial drug Echuramoo li Leaf Chooranam at the dose level of 2 00 mg significantly reverse the above parameters and turn towards the normal va lue. This result supports the traditional use of Echuramooli Leaf Chooranam in the treatment of anaemia.

Gestational-neonatal iron deficiency suppresses and iron treatment reactivates IGF signaling in developing rat hippocampus

Gestational-neonatal iron deficiency, a common micronutrient deficiency affecting the offspring of more than 30% of pregnancies worldwide, leads to long-term cognitive and behavioral abnormalities. Preclinical models of gestational-neonatal iron deficiency result in reduced energy metabolism and expression of genes critical for neuronal plasticity and cognitive function, which are associated with a smaller hippocampal volume and abnormal neuronal dendrite growth. Because insulin-like growth factor (IGF) modulates early postnatal cellular growth, differentiation, and survival, we used a dietary-induced rat model to assess the effects of gestational iron deficiency on activity of the IGF system. We hypothesized that gestational iron deficiency attenuates postnatal hippocampal IGF signaling and results in downstream effects that contribute to hippocampal anatomic and functional deficits. At postnatal day (P) 15 untreated gestational-neonatal iron deficiency markedly suppressed hippocampal IGF activation and protein kinase B signaling, and reduced neurogenesis, while elevating extracellular signal-regulated kinase 1/2 signaling and hypoxia-inducible factor-1α expression. Iron treatment beginning at P7 restored IGF signaling, increased neurogenesis, and normalized all parameters by the end of rapid hippocampal differentiation (P30). Expression of the neuron-specific synaptogenesis marker, disc-large homolog 4 (PSD95), increased more rapidly than the glia-specific myelination marker, myelin basic protein, following iron treatment, suggesting a more robust response to iron therapy in IGF-I-dependent neurons than IGF-II-dependent glia. Collectively, our findings suggest that IGF dysfunction is in part responsible for hippocampal abnormalities in untreated iron deficiency. Early postnatal iron treatment of gestational iron deficiency reactivates the IGF system and promotes neurogenesis and differentiation in the hippocampus during a critical developmental period.

Therapeutic Controversies: Optimizing Anemia Management in Hospitalized Patients with End-Stage Renal Disease

To review available literature on the use of erythropoiesis-stimulating agents (ESAs) in patients with end-stage renal disease (ESRD) who require hospitalization and to provide recommendations for ESA use in this setting. Primary articles were identified by English-language MEDLINE search (1966-October 2008) using the MeSH headings: kidney failure (chronic), anemia, erythropoietin, darbepoetin, hospitalization, and hematinics. Relevant data presented at recent nephrology scientific meetings (2004-October 2008) were also identified. Identified studies were reviewed and information regarding hospitalization, ESA use, and patient outcomes was evaluated. Studies demonstrate that hospitalized patients with ESRD usually experience a decline in hemoglobin values. Contributing factors include infection, inflammation, and untreated iron deficiency. ESAs are used inconsistently during hospitalization, with less than 50% of hospitalized patients with ESRD receiving ESA therapy in some reports. Some controversy exists regarding optimal hemoglobin targets for ESA therapy in nonhospitalized patients with ESRD, and no targets are defined for hospitalized patients. Clinical trials examining in-hospital ESA use have primarily involved the intensive care population and excluded ESRD patients. Following the patient's hospitalization, lower hemoglobin values may persist for 6 months, despite increased ESA dosing. Variability exists in frequency of hemoglobin monitoring and ESA dose changes. To date, no clinical trials have evaluated different approaches to anemia management in hospitalized patients with ESRD, and there are no published guidelines in this area. Based on published observations and clinical experience, we offer recommendations for anemia management around the time of hospitalization in an attempt to define a more rational approach to ESA therapy in this population. Trials are needed to define optimal ESA dosing strategies and hemoglobin targets in hospitalized patients with ESRD.

An Economic Analysis of Anemia Prevention during Infancy

To compare the cost-benefit profile of reticulocyte hemoglobin content (CHr) with hemoglobin (Hb) alone and Hb as a component of the complete blood count (CBC) for detection and treatment of iron deficiency in 9- to 12-month-old infants. Cohort simulations were used to compare CHr with Hb from a societal perspective. Assumptions included a 9% prevalence of iron deficiency and testing characteristics/costs of CHr, Hb, and CBC (CHr <27.5 pg: sensitivity 83%, specificity 72%, $11; Hb <11 g/dL: sensitivity 26%, specificity 95%, $5; CBC Hb<11g/dL, $15), as well as cost of iron therapy ($61 for established anemia). Sensitivity analyses were performed. Under current market conditions, the incremental cost to diagnose and treat iron deficiency, compared with diagnosing and treating anemia by Hb, was only $22 per patient screened ($440 per case of anemia prevented; number needed to treat = 20). With a 10-year time horizon incorporating risks and costs of neurocognitive delays associated with untreated iron deficiency, the cost of the CHr strategy was $280 per case of anemia prevented. CHr is an affordable strategy to prevent anemia in infants with possible iron deficiency.

Immature Reticulocyte Fraction after Iron Therapy for Iron Deficiency Anemia.

Background: Automated counting of reticulocyte introduced new reticulocyte parameters such as immature reticulocyte fraction(IRF). IRF is thought to be more sensitive than absolute or corrected reticulocyte count for detecting recovery of bone marrow function. The aim of this study is to assess the role of IRF for predicting the response of therapy after treatment of iron deficiency anemia.Methods: Patients with previously untreated iron deficiency anemia (blood hemoglobin < 10.0g/dL and serum ferritin < 10ng/mL) were enrolled into this study. On the 8th day of iron therapy, Complete blood count(CBC) with reticulocyte count and IRF was assessed by RAM-1 reticulocyte autoanalyzer(Sysmex. Tokyo, Japan). IRF was defined as sum of the reticulocyte fraction of high-fluorescence intensity regions plus the fraction of middle fluorescence intensity regions. After 1 month of iron therapy, CBC was reassessed to evaluate the response of iron therapy. The correlation of the 8th day IRF and the change of hemoglobin level after 4 weeks of therapy was evaluated. The 8th day corrected reticulcyte count was also evaluated.Results: From Jan. 2001 to May 2003, 27 patients with iron deficiency anemia (3 men and 24 women) entered into this study. We evaluated 21 patients, excluding 6 patients who were lost to follow-up or refused blood sampling after 1 month of iron therapy. The range of pretreatment hemoglobin level was 3.3–9.7g/dL (median 7.5/dL). The 8th day IRF was 0.06–0.39(median 0.15). Ten patients had the low IRF (IRF ≤ 0.15). Four of them (40%) had their hemoglobin level increased by more than 3g/dL. On the other side, 11 patients had high IRF (IRF > 0.15) and 10 of them (91%) had their hemoglobin level increased by more than 3 g/dL. This difference was significant (P=0.024). However, the 8th day IRF was not correlated with the change of hemoglobin as strongly as the 8th day corrected reticulocyte count (Pearson coefficient 0.420 vs 0.693).Conclusion: For the patients with iron deficiency anemia, the 8th day of treatment IRF correlates with the response of iron treatment, but the 8th day of treatment corrected reticulocyte count has a stronger correlation.

Iron deficiency and iron excess damage mitochondria and mitochondrial DNA in rats.

Approximately two billion people, mainly women and children, are iron deficient. Two studies examined the effects of iron deficiency and supplementation on rats. In study 1, mitochondrial functional parameters and mitochondrial DNA (mtDNA) damage were assayed in iron-deficient (< or =5 microg/day) and iron-normal (800 microg/day) rats and in both groups after daily high-iron supplementation (8,000 microg/day) for 34 days. This dose is equivalent to the daily dose commonly given to iron-deficient humans. Iron-deficient rats had lower liver mitochondrial respiratory control ratios and increased levels of oxidants in polymorphonuclear-leukocytes, as assayed by dichlorofluorescein (P < 0.05). Rhodamine 123 fluorescence of polymorphonuclear-leukocytes also increased (P < 0.05). Lowered respiratory control ratios were found in daily high-iron-supplemented rats regardless of the previous iron status (P < 0.05). mtDNA damage was observed in both iron-deficient rats and rats receiving daily high-iron supplementation, compared with iron-normal rats (P < 0.05). Study 2 compared iron-deficient rats given high doses of iron (8,000 microg) either daily or every third day and found that rats given iron supplements every third day had less mtDNA damage on the second and third day after the last dose compared to daily high iron doses. Both inadequate and excessive iron (10 x nutritional need) cause significant mitochondrial malfunction. Although excess iron has been known to cause oxidative damage, the observation of oxidant-induced damage to mitochondria from iron deficiency has been unrecognized previously. Untreated iron deficiency, as well as excessive-iron supplementation, are deleterious and emphasize the importance of maintaining optimal iron intake.

Immunohistochemical Assessment of Ferritin in Bone Marrow Trephine Biopsies: Correlation with Marrow Hemosiderin

In 340 bone marrow biopsies we compared ferritin, stained with an immunoperoxidase method, with hemosiderin, stained with Perls' reaction. Ferritin and hemosiderin showed the same distribution in reticuloendothelial cells. All the Perls-positive cases (n = 177) were ferritin-positive too. None of the ferritin-negative cases (n = 13) were Perls-positive. Of 163 cases with negative Perls' reaction in bone marrow, 13 (12.5%) were also ferritin-negative: these patients were mainly affected by polycythemia vera or by untreated iron deficiency anemia. Thus, immunohistochemical assessment of bone marrow ferritin can be a more sensitive tool for the evaluation of body iron stores in iron deficiency than Perls' reaction.