Path Image

This patient had ALL and received multiple blood transfusions. Although somewhat difficult to tell in this image, the iron deposition is more prominent in the Kupffer cells.

In secondary iron overload, the iron initially accumulates in the Kupffer cells (liver macrophages).

Prussian blue stain highlights iron deposition. Prominent iron accumulation in Kupffer cells favors secondary iron overload.


Iron overload (hemosiderosis) can be primary or secondary. Knowing the pattern of hemosiderin deposition can help in distinguishing between the two (Lefkowitch).

Secondary iron overload: These patients have received multiple blood transfusions due to sickle cell anemia or a thalassemia. Extensive Kupffer cell hemosiderosis with moderate hemosiderosis in hepatocytes is seen. Iron accumulation occurs initially in the Kupffer cells (macrophages) and when saturated, iron will spill over to the hepatocytes.

Primary iron overload: The classic example is hereditary hemochromatosis. In this case, it is the hepatocyte who is the primary place of iron accumulation with spillover in the Kupffer cells.


Liver : Hemochromatosis


Iacobuzio-Donahue CA, Montgomery EA. Gastrointestinal and Liver Pathology: Foundations in Diagnostic Pathology. Philadelphia, PA: Elsevier; 2005: 505-6.

Lefkowitch JH. Anatomic Pathology Board Review. Philadelphia, PA: Elvesier; 2006: 162.

Last updated: 2010-09-19
For questions, comments or feedback on this case: