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'.)
- Hazarika B. Touch imprint matters…. Blood 2013; 121:2585.
- Leyssen MH, Verwilghen RL. Diagnosis of bone marrow necrosis. Clin Lab Haematol 1979; 1:197.
- Kiraly JF 3rd, Wheby MS. Bone marrow necrosis. Am J Med 1976; 60:361.
- Brittin GM, Brecher G. Appearance of bone marrow smears with necrotic tumor cells. Blood 1971; 38:229.
- Paydas S, Ergin M, Baslamisli F, et al. Bone marrow necrosis: clinicopathologic analysis of 20 cases and review of the literature. Am J Hematol 2002; 70:300.
- Hamidou M, Rigal-Huguet F, Moreau A, et al. [Bone marrow necrosis in malignant hemopathies. 7 cases]. Rev Med Interne 1993; 14:958.
- Dunn P, Shih LY, Liaw SJ, Sun CF. Bone marrow necrosis in 38 adult cancer patients. J Formos Med Assoc 1993; 92:1107.
- Miyoshi I, Daibata M, Ohtsuki Y, Taguchi H. Bone marrow necrosis. Br J Haematol 2005; 130:467.
- Daskalakis M, Caballero M. Bone marrow necrosis in de novo AML. Blood 2014; 123:2137.
- Parekh HD, Reese JA, Cobb PW, George JN. Bone marrow necrosis discovered in a patient with suspected thrombotic thrombocytopenic purpura. Am J Hematol 2015; 90:264.
- Pereira RM, Velloso ER, Menezes Y, et al. Bone marrow findings in systemic lupus erythematosus patients with peripheral cytopenias. Clin Rheumatol 1998; 17:219.
- Bulvik S, Aronson I, Ress S, Jacobs P. Extensive bone marrow necrosis associated with antiphospholipid antibodies. Am J Med 1995; 98:572.
- Voulgarelis M, Giannouli S, Tasidou A, et al. Bone marrow histological findings in systemic lupus erythematosus with hematologic abnormalities: a clinicopathological study. Am J Hematol 2006; 81:590.
- Resende LS, Mendes RP, Bacchi MM, et al. Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy. Histopathology 2009; 54:486.
- Abdulsalam AH, Khamis MH, Bain BJ. Diagnosis of cystinosis from a bone marrow aspirate. Am J Hematol 2013; 88:151.
- Serrier C, Lesesve JF. Metastatic malignant melanoma in the bone marrow. Blood 2013; 121:721.
- Tavil B, Cetin M, Gumruk F. Sea-blue histiocytes in the bone marrow of a boy with severe congenital neutropenia associated with G6PC3 mutation. Br J Haematol 2014; 165:426.
- Pongas G. Sea-blue-colored histiocytes associated with bone marrow granulomas. Blood 2013; 122:475.
- Naghashpour M, Cualing H. Splenomegaly with sea-blue histiocytosis, dyslipidemia, and nephropathy in a patient with lecithin-cholesterol acyltransferase deficiency: a clinicopathologic correlation. Metabolism 2009; 58:1459.
- Lorenzoni PJ, Cardoso E, Crippa AC, et al. Niemann-Pick disease type C: a case series of Brazilian patients. Arq Neuropsiquiatr 2014; 72:214.
- Hirayama Y, Kohda K, Andoh M, et al. Syndrome of the sea-blue histiocyte. Intern Med 1996; 35:419.
- Emani M, Malhotra S, Rana F. Bone marrow aspirate showing Histoplasma capsulatum. Blood 2014; 123:957.
- Suner L, Mathis S. Disseminated cryptococcosis in bone marrow. Blood 2014; 123:3070.
- Bennett JM, Catovsky D, Daniel MT, et al. Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American-British Cooperative Group. Ann Intern Med 1985; 103:620.
- Harris NL, Jaffe ES, Diebold J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 1999; 17:3835.
- Ghara N, Portsmore S, Yardumian A, Bain BJ. Salmonella colonies in a bone marrow film. Am J Hematol 2014; 89:780.
- 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
- - Chronic lymphocytic leukemia
- - Chronic myeloid leukemia
- Myelodysplastic syndrome
- Multiple myeloma
- Waldenström macroglobulinemia
- Primary myelofibrosis
- Essential thrombocythemia
- Systemic infection
- Iron stores
- SUMMARY AND RECOMMENDATIONS