BONE MARROW STUDIES

The Bone Marrow

- Occupies 3.4% to 5.9% of TBW(1600-3700 g)

- At birth, all bones contain the hematopoietic (red) marrow
- 5th / 7th year: yellow marrow begin to replace the red marrow in the long
bones of extremities

Sites of collection

- ADULTS: anterior iliac crest, **superior iliac crest, ribs & vertebrae
- CHILDREN < 1 y/o: anteromedial surface of tibia

BM Aspiration and Biopsy

- 2 parts of the BM sample

o Aspirate: useful for cytologic type & proportions of hematopoietic cells
in the blood.
o Core biopsy Specimen:
- determine cellularity & the anatomic relationship of cells to fat and CT
stroma: important for determining/evaluating diseases that
characteristically produce focal lesions; also allows evaluation of bone
spicules.
- used to confirm aplastic anemia
* dry tap unable to aspirate BM cell during aspiration of BM

Indications of marrow exam

- Not required for cases of anemia: etiology is apparent by the RBC indices and
other laboratory tests.
- Multilineage abnormalities in the PB
- Circulating blasts (except in NB or infants w/ infection)
- Pancytopenic patients (except those who are receiving BM-suppressive
therapy)
- Staging/grading purpose in Hodgkin lymphoma and carcinoma.
*Should only be performed where it is essential fro diagnosis or patient
management.

Bone Marrow Procedures

- Needles : Jamshidi, Westerman-Jensen, Snarecoil

o Possible to obtain a core of a bone and its enclosed marrow
o 25 gauge replaced by 21 gauge
- 10-20mL syringe (1 to 2 cc)
- Position: right or left lateral decubitus
- Universal precaution
o Anaesthetic solution: 1% or 2% lidocaine or procaine (create a papule
using a 25 gauge needle)
 o Draped
- 2mL anaesthetic solution
- Incision (3mm, No. 11 scalpel)
- Aspirated particles: syringe to glass cover slips washed w/ 70% ethanol
- Second coverslip: pull aprt/ slides
- Wright Giemsa Stain
- Marrow core: touch preparation fixed w/ Zenkers solution, 5% glacial acetic
solution buffered solution

Aspirates

- LPO
o Detect the presence of bone spicules (intact marrow consisting of the
hematopoietic and stromal elements of the BM)
- OIO
o Hematopoietic cells
o Count 300 to 500 nucleated RC to obtain a reliable differentaial count
to determine the M:E ratio
o 1.5:1 3.3:1 (mean: 2.3: 1)

Note : myelocyte, metamyelocyte, monocyte, megakaryocytes

Cellularity
- Estimated by observing the proportion of cells to empty fat vacuoles
- Relative cellularity