Marrow Iron

Abstract

Consecutive unselected bone marrow sections obtained by a modified needle biopsy procedure were examined for Fe stores using the Prussian blue reaction. Absent marrow Fe stores were present in 442 of the 1,332 biopsy specimens for an incidence of 33%. The clinical records of 300 of these patients indicated that Fe deficiency was not clinically recognized in 55%. Fifty percent of 38 patients with rheumatoid arthritis and 14 patients with systemic lupus erythematosus had absent marrow Fe stores. All 19 patients with untreated poly-cythemia vera had absent marrow Fe stores. In contrast, 23 of 25 patients with secondary polycythemia had normal or increased marrow Fe content. Fifty-seven instances of absent Fe stores were present in the 151 patients with various infiltrative diseases of the marrow while 6 patients with uremia and 10 with chronic infections had absent Fe stores. The high incidence (55%) of occult Fe depletion which is significantly larger than previously noted (16-26%) reemphasizes the value of marrow Fe examination. The large proportion of depleted stores in patients with connective tissue disease and infiltrative disease of the marrow indicate that Fe deficiency may be a significant factor in the anemia of many patients with these diseases. The regular finding of marrow Fe depletion in untreated polycythemia vera was not previously described and affords a means of differentiating primary from secondary polycythemia. The anemia of uremia and chronic infection may occasionally be due to occult Fe deficiency.