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Bone marrow examination
- 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
- 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
- 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?