Introduction to interpreting bone marrow aspiration reports

1. JG Nel
Dept Haematology and Cell biology

2.  The type of information that can be gained from
this investigation
 The report
 Objective data
 Terminology often used in reports
 Interpretation
 Take home message

3.  used to
 diagnose
 confirm and or stage haematologic disease
 a diagnostic tool in non-haematologic disorders
and malignancies

4.  Demonstration of fine cytological detail
 Quantitative data on the relative constituents
of the bone marrow
 Can be used for investigating:
 Iron deficiency anaemia
 Anaemia of chronic disease
 Megaloblastic anaemia
 Acute leukaemia

5. Two components
 Factual component
 Description of the aspirate
 Counts
 Interpretive component
 Final summary and interpretation

6.  Cellularity
 Evaluated on aspirated
bone marrow fragments
 Varies with the extremes
of age
 “Normal” =30%-65%

7. The counts:
M:E ratio
 2-3:1
 Together with cellularity helps determine
wether granulopoiesis/erythropoiesis is
hyperplastic

8. Haemopoiesis
 Erythropoiesis
 Granulopoiesis
All the individual stgs
evaluated.
Reported as
 Active
 Hypoplastic
 Hyperplastic

9. Iron stain
 Perl’s stain
 Stains haemosiderin
 Iron stores reported as
 Depleted
 Reduced
 Normal
 Overloaded

10. Sideroblasts
 Siderotic granules
normal in the
cytoplasm of many
erythroblasts in bone
marrow
 Normal: 10%-25%
 Chronic infections:
iron stores
sideroblasts

11. Megakaryocytes
 Largest of normal
bone marrow cells
 Undergo
endoreduplication as
they mature
 Classified by their
ploidy
 demand for plt size
and ploidy

12. Blasts
 Immature precursor
cells
 Normal numbers in
bone marrow vary with
age
 Normal in adults:
 2% myeloblasts

13.  Myelodysplasia vs myelodysplastic syndrome
Morphological feature vs Diagnosis
 MDS
 Dysplastic and innefective clonal haemopoiesis
 Neoplastic pre-leukaemic conditions
 Secondary myelodysplasia
 Polyclonal haemopoiesis
 NOT neoplastic or pre-leukaemic
 Potentially reversible

14.  Most common causes:
 Infectious
▪ HIV
▪ Tb
 Critical illness with multi-organ failure
 Exposure to drugs and toxins

15.  Megakaryocytic
thrombocytopenia
What does this term
mean?

16.  the answer generated by a special
investigation can never be better than
 The specimen submitted
 The clinician responding to it

17.  Does not stand alone
 CLINICAL PICTURE
 Specific indications
 Specific applications
 Specific limitations