Bone marrow examination

1. BONE MARROW
EXAMINATION
Dr.T.Arivazhagan
Post graduate
Department of Pathology

2. Needs ?
• It provides the semi – quantitative & qualitative
assessment of the state of hematopoiesis.
• It can be
1. Bone marrow aspiration
2. Bone marrow biopsy

3. Structure of bone
1. Cortex – outer
2. Medulla – inner

4. Normal bone marrow
• One of the largest organ in the body
• Located with in the cavities of the bone
• Consists of
• Hematopoietic cells
• Vascular sinusoids
• Fibroblasts
• Fat cells
• Macrophages
• No lymphatic channels in the

5. Types
Red marrow
1. Active portion
2. Contain hematopoietic cells
Normal value : 3000-4000ml
Red marrow : 1500ml
Yellow marrow
1. Inactive portion
2. Contain fat cells

6. • Amount of fatty tissues depends on activity of the
hematopoietic cells.
• Children's – 20-30% of fat cells
• Adults – 50% of fat cells
• Elder – 70% of fat cells.

7. Aspiration indication
1. Unexplained cytopenias
2. Suspected acute leukemia
3. Suspected MDS
4. Suspected MPD
5. Suspected Plasma cell disorders
6. Suspected CLL
7. PUO
8. Suspected storage disorders
9. Suspected infections

8. Biopsy indication
1. Repeated failure of aspiration
2. Suspected Aplastic anemia
3. Suspected Myelofibrosis
4. Suspected Focal lesions like granuloma,
metastatic deposits.
5. Suspected hairy cell leukemia
6. Staging of lymphoma.

9. Contraindication
1. Coagulation disorders
2. Local infections

10. Sites
• Iliac spines or crest > 1 year
• Posterior iliac crest
• Large reservoir of marrow
• No large blood vessels
• No nerves close to this area
• Sternum
• At the 2nd intercostal space in midline
• Tibia
• <1 year
• Medial aspect of upper end of tibia

11. Instruments
Aspiration Biopsy

12. Aspiration procedure
1. Informed consent
2. Sterile tray
3. Position of the patient
4. Skin & periosteum infiltrated with local
anesthetic agents
5. Wait for 5 minutes

13. • Needle is inserted with stylet (prevent the blockage of
the lumen by tissues)
• Once reach the bone needle rotate clock & anti clock
wise
• Decreased resistance felt once reach the bone marrow
• Needle advanced into the marrow 1-2 mm
• Small amount(0.25-0.50ml or till the 1st drop of blood
appears) of marrow aspirated by using 5 or 10 ml
syringe

14. Biopsy procedure
• Sedatives – Intravenous , General
• Percutaneous trephine biopsy material commonly
obtained from posterior superior iliac spine
• Rotating it clockwise 10 times
• Needle removed by anti clock wise
• 1.6cm in length
• Fixative solution ( Helly’s Fluid)

15. Complications
1. Local infections
2. Hemorrhage
3. Cardiac tamponade
4. Mediastinitis

16. Comparison
Parameters Aspiration Biopsy
Site Iliac spine, Sternum, Iliac spine
Information
Morphology
Cytochemistry
Iron stain
Culture
Cellularity
Architecture
Focal lesions
Needle
Salah
Klima
Jamshidi
Stain
Romanowsky stain
Iron stain
H & E stain
Reticulin stain
Result Same day With in 7 days

17. Aspiration examination
1. Cellularity ( Deducting 1 for each year of age from 100)
2. Differential count
3. Myeloid : Erythroid ratio ( 2:1 to 4:1)
4. Erythroid series
5. Myeloid series
6. Megakaryocyte series
7. Lymphocyte series
8. Plasma cell series
9. Abnormal cells
10. Parasites

18. Identification
1. Megakaryocyte
2. Fat cells
3. Cellular trails

19. Iron deficiency anemia

20. Megaloblastic anemia
Megaloblastic series are seen
Erythroid hyperplasia
Giant metamyelocytes
Band forms

21. 1. Large
2. Deep Basophilic
cytoplasm
3. Prominent nucleoli
4. Fine nuclear
chromatin

22. Assessment
1. Needs ?
2. Types ?
3. Indications ?
4. Name of the aspiration needle?
5. Name of the biopsy needle?
6. Identification ?
7. Bone marrow findings of IDA & MA?