Dr. Aye Aye Tun

Pathology Unit, Faculty of Medicine

RCMP, UniKl

Purpose1. To confirm the diagnosis

2. To assess the response to the

treatment

3. To obtain the specimen for

microbiological examination

4. To obtain the specimen for research

5. To obtain the aspiration of bone

marrow for transplantation

Types

1. Bone marrow aspiration

2. Bone marrow trephine biopsy

Bone marrow aspiration

1. Leishman's stain

2. Special stain for iron storesIron stain (Perl's Prussian blue reaction)presence of ironbluish green area

3. Cytochemical stain

4. Immunocytochemical stain

Prussian blue stains of bone marrow aspirates in normal (left) and iron-deficiency states (right)

Bone marrow trephine biopsy

1. Haematoxylin and Eosin stain

- histological examination

2. Histochemical stain

3. Immunohistochemical stain

Advantages of BM aspiration1. Simple2. Safe3. Relatively painless4. Can be repeated many times5. Can be performed at OPD6. Morphology of haemopoietic cells can be simply identified.

Disadvantages1. The arrangement of the cells in the marrow and the relationships between one cell and another are more or less destroyed by the process of aspiration

2. Fibrotic marrow and highly cellular marrow → Dry tap

Advantages of Trephine biopsy1. Can provide a perfect view of the structure of relatively large pieces of marrow2. Superior to BM aspiration in some circumstances e.g. for diagnosing marrow involvement by malignant lymphomas or non-haematological neoplastic diseases

Both BM aspiration and Trephine biopsy have an important and complementary role.

Sites1. Sternum2. Iliac spines (PSIS)3. Spinous process (Lumbar vertebrae)4. Heel (Children)

BM Aspiration Needle• 1. Salah and Klima needle• 2. Islam needle

Salah and Klima needleSalah and Klima needle

Islam's bone-marrow Islam's bone-marrow aspiration/trephine needleaspiration/trephine needle

Bone marrow films

1. Direct smear preparation

2. Concentration of BM by centrifugation

(Poorly cellular samples)

Examination of BM film

1. BM fragments and cellularity

2. Erythropoiesis

3. Leucopoiesis

4. Megakaryopoiesis

5. M:E Normal 3-4:1 (15:1)

6. Presence of foreign cells

7. BM iron stain (Perl’s Prussian blue)

normal bone marrow at medium magnification

normal bone marrow at medium magnification

normal bone marrow at medium magnification

Bone Marrow Biopsy

Markedly hypocellular marrow which is largely devoid of hematopoietic cells and contains mainly fat cells, fibrous stroma, scattered lymphocytes and plasma cells

A - a markedly hypocellular bone marrow (<5%cellularity)B - approximately 40% cellularityC - bonemarrow with nearly 100% cellularity

normal bone marrow smear

erythroid precursors

granulocytic precursors

Marrow smear from a patient with hemolytic anemia

ERYTHROID HYPERPLASIAThe marrow reveals greatly increased numbers of maturing erythroid progenitors (normoblasts)

Marrow smear from a patient with anemia

Megaloblasts in various stages of differentiation.

granulocytic precursors

Orthochromatic megaloblast