Bone marrow

Yellow bone marrow

Adipocytes or fat cells

Indications for bone marrow examination

• Neoplasia diagnosis: acute leukemias, chronic leukemias, myelofibrosis

• neoplasia diagnosis and staging: hodgkin and non-hodgkin lymphoma

• metabolic disorders: geucher diagnosis, mast cells disease

• infections: granulomatous disease, fungal infections

• monitoring of treatment: after chemotherapy or radiation therapy after stem cell treatment

Bone marrow is prohibited on patients with:

Hemophilia or vitamin K; must monitor patients with thrombocytopenia and patients receiving anticoagulant therapy (not off the table, but proceed with caution).

What is the preferred location for a bone marrow specimen?

Posterior superior illiac crest of the pelvis (1st) or anterior superior illiac crest of the pelvis (2nd)

Why are the sternum and anterior medial surface of the tibia not the preferred location for bone marrow?

These locations are not preferred since they do not provide a good specimen for core, only aspiration.

Dry tap

The first and second tap are unsuccessful if the bone marrow is fibrotic, acellular, or packed with leukemic cells.

what is the aspiration of the bone marrow?

marrow aspiration is the liquid part that is also from the same biospy site.

Direct aspirate smears

From the aspirate of bone marrow. Needs spicules from the blood.

when are buffy coats used for smears?

They are used when there isnt enough nucleated cells from the direct bone marrow aspirate.

what are some components of a bone marrow examination?

• cellularity

• megakaryocytes

• maturation

• additional hematologic cells

• stromal cells

• differential count

• myeloid to erythroid ration

• iron stores

____ is used to stain aspirate smears using the same procedure as for peripheral blood staining.

wright or wright-giemsa stain

____ is used to stain aspirate or core biopsy specimens to detect and estimate marrow storage iron or iron metabolism abnormalities.

An acidic potassium ferrocyanide (prussian blue)

Prussian blue stains iron stores; what would you report this iron store 0-4+?

4+ (all the blue stain)

Prussian blue stains iron stores; what would you report this iron store 0-4+?

0 (all the yellow is an iron store that needed to be blue for iron)

What are some things we look for in low power examination of the bone marrow?

• assess peripheral blood dilution

• find bony spicules and areas of clear cell morphology

• observe fat to marrow ratio, estimate cellularity

• examine and estimate megakaryocytes

• malignant cells like to cluster

An _____ is a bone forming cell that is derived from the mesenchymal osteoprogenitor cells and is involved in the bone remodeling process (or involved in the formation and mineralization of bones).

Osteoblast

An _____ is a type of bone cell that is responsible for the bone reabsorption (involved in the bone breakdown and bone reabsorption).

Osteoclast

How is the Myeloid to erythroid ratio calculated?

# of myeloid (granulocytic cells)/ # of erythroid cells

what is the normal M:E ratio?

3:1

_____ is the standard dye for bone marrow core biopsy specimen.

Hematoxylin and eosin

Why are bone marrow core biopsy’s important when the aspirations procedure yields a dry tap?

Imprint (touch preparations) of the bone marrow biopsy’s are important during dry taps because it may be an indication of hypoplastic or aplastic anemia, fibrosis, or tight packing of the marrow activity with leukemic cells.

What is the advantage and disadvantage of core biopsy?

Advantage: preservation of the bone marrow architecture allows cells, tumor clusters, and maturation stages to be examined relative to stromal elements.

Disadvantage: individual hematopoietic cell morphology is obscured.

How to examine the core biopsy?

1. examine at 10x to observe cellularity (Because the sample is larger, the core specimen provides a more accurate estimate of cellularity and the fat-to-cell ratio then the aspirate).

2. Examine the core biopsy at 50x for cell distribution relative to bone marrow stroma.