Bone marrow examination

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 Bone marrow aspiration Bone marrow biopsy

3. Structure of bone Cortex – outer 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 Active portion Contain hematopoietic cells Normal value : 3000-4000ml Red marrow : 1500ml Yellow marrow Inactive portion 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 Unexplained cytopenias Suspected acute leukemia Suspected MDS Suspected MPD Suspected Plasma cell disorders Suspected CLL PUO Suspected storage disorders Suspected infections

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

9. Contraindication Coagulation disorders 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 2 nd intercostal space in midline Tibia <1 year Medial aspect of upper end of tibia

11. Instruments Aspiration Biopsy

12. Aspiration procedure Informed consent Sterile tray Position of the patient Skin & periosteum infiltrated with local anesthetic agents 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 1 st 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 Local infections Hemorrhage Cardiac tamponade 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 Cellularity ( Deducting 1 for each year of age from 100) Differential count Myeloid : Erythroid ratio ( 2:1 to 4:1) Erythroid series Myeloid series Megakaryocyte series Lymphocyte series Plasma cell series Abnormal cells Parasites

18. Identification Megakaryocyte Fat cells Cellular trails

19. Iron deficiency anemia

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

21. Large Deep Basophilic cytoplasm Prominent nucleoli Fine nuclear chromatin

22. Assessment Needs ? Types ? Indications ? Name of the aspiration needle? Name of the biopsy needle? Identification ? Bone marrow findings of IDA & MA?