Iron stores are generally assessed using bone marrow aspiration from the iliac crest. However, the sternum is also used to perform aspiration. Are the results comparable in humans? In the cited article, both sample cites are used, did you find any differences?
Article How should stainable iron in bone marrow films be assessed?
No difference that I known of. Bone marrow aspiration is a very insensitive method for determining Iron stores.
To my knowledge, bone marrow aspiration is still considered the gold standard for assessing iron stores. Especially in patients with low grade inflammation, in which ferritin is not eligible. Which method do you think is more sensitive for determining iron stores?
I know that it is still considered the "gold standard" but, it is only considered the gold standard because we do not have a single test to replace it. It all depends on your specific research question, how you will go about it.
The evaluation of iron stores on aspirated bone marrow imo is a very subjective procedure, and extremely dependent on specimen quality.
I want to assess the sensitivity and specificity of serum markers of iron status (such as the % of hypochromic reticulocytes) in patients with low grade inflammation. Therefore, I need a 'gold standard' as comparison.
How about reticulocyte haemoglobin in combination with soluble serum transferrin receptors in combination with log ferritin values? i.e. the Thomas plot?
Am J Clin Pathol. 2012 Nov;138(5):642-9. doi: 10.1309/AJCP16NTXZLZFAIB.
Soluble transferrin receptor (sTfR) and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia. A meta-analysis.
Infusino I1, Braga F, Dolci A, Panteghini M.
Niels, bone marrow aspirate is a very complex sample. There is no gold standard. You need to count with a variability per patient. I do not expect significant difference between sternum and iliac crest, however. It is more about a technique itself and a sample volume (generally, more volume you take out, more dilution with peripheral blood you get). This factor might be more important in sternum in you go above 2-3 ml.
Dear Martin, thank you for your answer. We aspirate around 3-4mL and assess iron stores using Prussian Blue staining of spicules. How I see it is, that whenever spicules are present, iron stores can be assessed. No matter if the bone marrow is contaminated with peripheral blood. Could you explain how dilution does affect the results?
I think we must consider the ethic problem: it's not correct to perform the bone marrow aspiration and examination in a suspected chronic diseases anemia because no more information can come from this site. Furthermore, i agree with dr. Klabusay and dr. Jan-Gert Nel: the Perls reaction is not the "gold standard" for iron storage evaluation because it is only semi-quantitative
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