The effect of decalcification and choice of fixative on histiocytic iron in bone marrow core biopsies

Iron stains are often used for bone marrow core biopsies obtained by needle biopsy of the iliac crest. Because bone must be decalcified by brief treatment with acid, it is possible that an undetermined amount of stainable histiocytic iron may be lost. A study was carried out to determine whether decalcification results in loss of histiocytic iron and the effects of fixatives and the recovery of histiocytic iron in decalcified bone marrow tissue. Aspirates of bone marrow were stained for iron with Prussian blue. Because aspirate material does not require decalcification, it served as a control for the study. One hundred bone marrow biopsies and accompanying aspirates from 100 adult subjects were evaluated, Fifty bone marrow biopsies were fixed using a fixative containing mercuric chloride (B-5) and the remaining 50 were fixed in zinc-formalin. Histiocytic iron was graded as minimal, moderate or marked depending on whether less than 5, 6-10, or more than 10 iron positive histiocytes, respectively, were observed. When histiocytic iron was markedly present in aspirate material, at least moderate amounts of stainable iron were found in 22 of 25 B-5 fixed and 21 of 25 zinc-formalin fixed decalcified bone marrow. When aspirate histiocytic iron was minimal or moderate, 14 of 25 B-5 fixed and 7 of 25 zinc-formalin fixed decalcified bone marrow specimens revealed histiocytic iron. Decalcification results in decreased recovery of stainable iron, and where histiocytic iron is minimally or moderately present, B-5 fixation results in greater postdecalcification recovery. There was no significant difference in recovery when larger quantities of histiocytic iron were present prior to the decalcification step.