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The page below is a sample from the LabCE course Liver Biopsies: Anatomy and Histological Considerations. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Prussian Blue

Prussian blue is a term that references both a stain and staining reaction. Prussian blue is used to demonstrate ferric (+3 charge) iron in tissues. A liver biopsy is used to diagnose both hereditary hemochromatosis and hemosiderosis. Hemochromatosis and hemosiderosis are both conditions that cause the liver to accumulate excess iron. Iron can be seen as a brown pigmentation on a hemotoxylin and eosin (H&E) stained tissue slide but may be difficult to distinguish from other pigments. Therefore, an iron stain is commonly used to positively identify iron in the liver. The mode of action for the Prussian blue iron stain is to treat the tissue with an acidic solution (hydrochloric acid). Ferric (+3 charge) iron that is present in the tissue will react with this solution to form Prussian blue which is visualized as an insoluble blue pigment. In the image, a liver biopsy stained with Prussian blue is used to demonstrate ferric iron in a patient with hemochromatosis.