Anemia of chronic disease - bone marrow iron stain

Section of a bone marrow aspirate taken from a patient with the anemia of chronic disease. The slide has been stained for iron (Prussian blue reaction) and counterstained with safranin to show nuclear detail. Note the increased iron staining within the voluminous cytoplasm of macrophages (thick black arrows), while there is no staining for iron within the cytoplasm of red blood cell precursors (thin black arrows). This pattern (abundant iron in macrophages and reduced to absent iron in red cell precursors) is quite typical for the anemia of chronic disease, and contrasts with iron deficiency, in which iron is absent from both macrophages and red cell precursors, while normal subjects demonstrate iron in macrophages and red cell precursors.