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Iron Stain on Bone Marrow Aspirate Smears Interfering with Assessment of Iron Stores and Sideroblasts

Monalisa Ntobongwana

Bone marrow examination for assessment of iron status is an important part of the evaluation of patients with both haemopoietic and non haemopoetic disorders. An iron stain is the gold standard for the assessment of the body’s iron status. It also allows the detection not only of an increased or decreased proportion of sideroblasts (iron containing nucleated red blood cells) but also of abnormal sideroblasts hence is valuable in the diagnosis of various hematological diseases. The quality of the stain is hence pivotal in hematology. In my laboratory, I have noticed for a prolonged period of time an artefact on our iron stain which made it difficult to assess iron stores and impossible to assess the percentage of sideroblasts. I undertook this troubleshooting investigation to determine the possible cause and solution to these artefacts. In literature there is paucity of information about the causes of Perl’s Prussian blue stain artefacts in hematology specimens most suggestions attributing the artefact to the age of the stain and suggesting making up fresh stain to filtering the stain reagent Saffranin-O to remove any impurities from the stain as this reagent tends to form precipitates. Such measures were attempted but were unhelpful in resolving the artefact. The results of this troubleshooting showed that storing Saffranin-O in a plastic contained after reconstituting the powder to a solution was the cause of the artefact and the practice has since been changed to storing the Saffranin-O stock solution in a glass bottle.