Introducing a new histologic scoring system for iron deposition in liver in thalassemia major, compared with atomic absorption spectrometry

Introduction: Iron deposition in liver is a major finding in thalassemic patients. Histologic grading of iron deposition is widely used in many institutions and various grading systems have been introduced. The aim of this study was to introduce a new histologic scoring system (Markaze Tebbi Koodakan: MTK 1, 2 and 3) which considers size and density of iron granules as well as zone of iron deposition and verify this system with atomic absorption spectrometry (AAS method). Materials and methods: Liver biopsies from 63 patients were evaluated, 40 (63.5%) were male and 20 (36.5%) were female. The mean age of the patients was 8.01±3.7 and the age range was from 1.8 to 15 years. Iron scoring was performed according to Sindram & Marx and MTK 1-3 scoring systems.Paraffin blocks were processed for AAS and the results of the iron analysis (HIC: hepatic iron concentration) were reported as µmol/g dry liver weight. The statistical analysis was performed using SPSS, version 16 (SPSS Inc., Chicago, IL, USA). Results: The mean (SD) of hepatic iron concentration was 230.9 (121.2) µmol/g dry weight. The relationship between the variables HIC, HII (hepatic iron index) and all histological grading of iron (S&M and MTK1-3) was very strong. Significant differences were identified between the mean HIC in scores 1 & 2 of all histological iron scorings (S&M and MTK 1-3), but no significant differences identified in other adjacent scores in all histological iron scorings (S&M and MTK 1, 2 and 3). Discussion and conclusion: New scoring system introduced by us in this study was very much the same as simple Sindram and Marx classification. So it is concluded that although size of iron granules is important in lower scores, but in higher scores it is not as much important as the zone in which iron granules are deposited.