Evaluation of bone marrow aspirate smears
- David S Rosenthal, MD
David S Rosenthal, MD
- Professor of Medicine
- Harvard Medical School
Aspiration and biopsy of the bone marrow is used to diagnose, confirm, and/or stage hematologic disease, and is a diagnostic tool in non-hematologic disorders (eg, storage disease, systemic infection) and malignancies. It is an ambulatory procedure performed under local anesthesia, with low morbidity.
The evaluation of bone marrow aspirate smears will be discussed here.
Details of the bone marrow aspirate and biopsy procedure, additional testing performed on the bone marrow, and complications of the procedure are discussed separately. (See "Bone marrow aspiration and biopsy: Indications and technique".)
Evaluation of the peripheral blood smear is also covered separately. (See "Evaluation of the peripheral blood smear".)
As described separately, the clinician performing the procedure should check with the hematopathology laboratory prior to the procedure for clarification about slide preparation and collection of additional specimens for cytogenetics, immunologic studies, and/or cultures, as well as guidance concerning timely evaluation of the collected material by the clinician and the hematopathologist. It is often helpful to have another person at the procedure to help make the aspirate smears before the sample forms a clot. (See "Bone marrow aspiration and biopsy: Indications and technique", section on 'Preparation of samples'.)
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- SAMPLE PREPARATION
- The dry tap
- Bone marrow necrosis
- LOW POWER EXAMINATION OF THE MARROW
- Large cells
- Cells in clumps or clusters
- Storage cells
- Macrophages (histiocytes) with ingested cells or debris
- Estimation of cellularity and myeloid to erythroid ratio
- HIGH POWER EXAMINATION OF THE MARROW
- Megaloblastic changes
- - Acute lymphoblastic leukemia
- - Acute myeloid leukemia
- - Acute promyelocytic leukemia
- - Chronic lymphocytic leukemia
- - Chronic myeloid leukemia
- Myelodysplastic syndromes
- Multiple myeloma
- Waldenström macroglobulinemia
- Polycythemia vera
- Primary myelofibrosis
- Essential thrombocythemia
- Systemic infection
- Iron stores
- SUMMARY AND RECOMMENDATIONS