Medical

1. BONE MARROW
EXAMINATION
T.
Arivazhagan
.
Dr

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

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

4. • 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
Normal bone marrow

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

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. 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
Aspiration indication

8. 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.
Biopsy indication

9. 1. Coagulation disorders
2. Local infections
Contraindication

10. • 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
• Iliac spines or crest > 1 year
Sites

11. Instruments
Aspiration Biopsy

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

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. • 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)
Biopsy procedure

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

16. 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
Comparison

17. 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
Aspiration examination

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

19. Iron deficiency anemia

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

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

22. 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?
Assessment