Tissue and Urinary Haemosiderin in Chronic Leg Ulcers

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Tissue and Urinary Haemosiderin in Chronic Leg Ulcers J. Tan, A. Smith, S. Abisi, D. Eastham, K.G. Burnand European Journal of Vascular and Endovascular Surgery Volume 34, Issue 3, Pages 355-360 (September 2007) DOI: 10.1016/j.ejvs.2007.02.006 Copyright © 2007 European Society for Vascular Surgery Terms and Conditions

Fig. 1 Typical haemosiderin granule stained positively with Perls' reagent under light microscopy. A, a haemosiderin granule in higher magnification. European Journal of Vascular and Endovascular Surgery 2007 34, 355-360DOI: (10.1016/j.ejvs.2007.02.006) Copyright © 2007 European Society for Vascular Surgery Terms and Conditions

Fig. 2 Results of urinary Haemosiderin analysis. Significant higher haemosiderin count was detected in patients with venous ulcer. No statistical differences were detected between venous ulcers against rheumatoid (p=0.15) and sickle cell ulcers (p=0.3) respectively. There was also a difference between venous ulcers and non-venous ulcers (p<0.005, Kruskal-Wallis) (not shown). xMann Whitney test. European Journal of Vascular and Endovascular Surgery 2007 34, 355-360DOI: (10.1016/j.ejvs.2007.02.006) Copyright © 2007 European Society for Vascular Surgery Terms and Conditions

Fig. 3 Sensitivity analysis in urinary haemosiderin. Venous ulcer; Sensitivity (22/24) 91%, Specificity (11/21) 52%, Positive prediction value (22/32) 69% and Negative predictive value (2/13) 15%. Ischaemic ulcer; Sensitivity (0/6) 0%, Specificity (6/6) 100%, Positive predictive value (0/22) 0% and Negative predictive value (6/8) 78%. European Journal of Vascular and Endovascular Surgery 2007 34, 355-360DOI: (10.1016/j.ejvs.2007.02.006) Copyright © 2007 European Society for Vascular Surgery Terms and Conditions

Fig. 4 Picture of a section showing extensive haemosiderin staining following Perls' reagent. Haemosiderin appeared to be confined to the dermis with no positive staining found in the epidermal region. European Journal of Vascular and Endovascular Surgery 2007 34, 355-360DOI: (10.1016/j.ejvs.2007.02.006) Copyright © 2007 European Society for Vascular Surgery Terms and Conditions

Fig. 5 Percentage of tissue haemosiderin strained in non-healing ulcers. Staining was performed on 38 samples. Apart from rheumatoid ulcer, there were significant differences detected in comparing venous ulcer against the other aetiologies in the study. [p values, 0.003 (Ischaemia), 0.033 (lymphoedematous) and 0.017 (sickle cells ulcers)]. European Journal of Vascular and Endovascular Surgery 2007 34, 355-360DOI: (10.1016/j.ejvs.2007.02.006) Copyright © 2007 European Society for Vascular Surgery Terms and Conditions

Fig. 6 Tissue Haemosiderin sensitivity test. Venous ulcer; Sensitivity (21/23) 92%, Specificity (8/22) 36%, Positive prediction value (21/35) 60% and Negative predictive value (2/10) 20%. European Journal of Vascular and Endovascular Surgery 2007 34, 355-360DOI: (10.1016/j.ejvs.2007.02.006) Copyright © 2007 European Society for Vascular Surgery Terms and Conditions