Utility of low hemoglobin density, intensive method of assessment and classification of bone marrow iron status in patients with dimorphic anemia

Abstract

Background : The increasing prevalence of combined nutritional deficiencies and co-morbidities has made usage of biochemical markers like serum ferritin, challenging in diagnosing cases of functional iron deficiency. Microscopic evaluation is the “gold standard” method for assessment of iron stores. In this study, we tried to distinction of iron store deficiency from functional iron deficiency and correlate the marrow iron stores with LHD%(Low hemoglobin density). Aim: To perform an intensive bone marrow iron grading by assessing iron in fragments, in macrophages around fragments and in erythroblasts and to correlate the marrow iron store results with LHD%. Materials and Methods: A descriptive study of Perl’s Prussian blue stained bone marrow aspirate smears of 62 adult patients with dimorphic anemia. Bone marrow iron was assessed by both the Gale’s method and the intensive method and correlated with LHD%. Results: The Conventional Gale’s grading revealed hypoferremic state in 32.26% cases and normal iron stores in 56.45% cases. The new Intensive method of grading, showed that most common was functional iron deficiency(35.48%), followed by normal stores, combined deficiency (functional & iron stores) and lastly iron stores deficiency. According to intensive grading method, most of the cases predominantly showed functional iron deficiency. LHD% was statistically significant with the groups obtained from intensive grading system. Conclusion: Intensive method of assessment of iron stores helps in identifying patients with functional iron deficiency. LHD% could be an easily available parameter to identify patients with iron deficiency.