Several people have noted problems with failure of the Perls prussian blue 
reaction to stain iron in marrow sections, when control sections (usually 
iron-laden liver) stained well.

I've signed out the better part of a thousand bone marrows in my career, in a 
variety of laboratories, and am not sure I've encountered this technical 
problem.

Certainly acidic decalcifying agents remove hemosiderin, as several people 
have noted. So do acid fixatives such as B-5. Neither of these problems 
should affect the iron staining of marrow smears, which should always be 
done, because the pathologist needs to look for ringed sideroblasts.

Iron depletion is extremely common in sick people, who are the ones who get 
bone marrow aspirations and biopsies done on them, after all. Careful review 
of the peripheral smear and the Coulter counter data is mandatory, and should 
never be omitted from the examination and the report. (Yes, it's billable - 
CPT 85060 unless you want to get greedy and try for 80502.)

In my personal experience, this clinical review nearly always provides an 
explanation for the observed lack of stainable iron in the marrow 
preparations.

It's always best to have your control match your test material as closely as 
possible. I'd suggest finding a marrow clot with adequate stainable iron, and 
using it as your control material. I'd certainly let you cut such a paraffin 
block into small pieces to make it last longer!

Is anybody phasing out nuclear fast red in favor of Anatech's Brazilliant 
(brazil wood extract with alum mordant) as their marrow counterstain? I've 
always insisted on nuclear fast red (rather than basic fuchsin or what have 
you) as a counterstain and am sorry to see that fine old dye go.

Bob Richmond
Samurai Pathologist
Knoxville TN