Bone Marrow Examination

Question 1

Bone Marrow Exam Indications

Answer 1

Most commonly used to monitor
-course of a disease
-effectiveness of treatment

Confirm suspected diagnosis
A few diseases can only be made by BM exam
-Lipid metabolism disorders
-MM
-Tumor metastasis
-Pancytopenia
-Aplasia
-Thrombocytopenia
-Lymphomas
-Myelodysplastic Syndromes (Refractory anemias)

Question 2

Sites of Bone marrow aspiration

Answer 2

Posterior iliac crest
Anterior iliac crest
Sternum

Question 3

BM Aspirate preparations

Answer 3

-Fresh aspirate smears – small gray marrow spicules - pull prep

-EDTA specimen- for flow cytometry

-Na+ heparin – for Cytogenetics

Question 4

BM Biopsy Preparations

Answer 4

-Touch Prep –uses core biopsy
-Preserved for Histology tissue sectioning

Question 5

Marrow Interpretation
Low Power (100x)

Answer 5

-Cellularity - Touch prep
Normal ratio fat to hematopoetic tissue is 50:50

-Megakaryocyte estimate
Reference: 3-6 / lpf ; OHSU 1% of wbcs

-Scan for focal infiltrates

Question 6

Marrow Interpretation
Oil Immersion (1000x)

Answer 6

Confirm focal infiltrates

Differential - Aspirate smears
-count 300 - 1000 wbcs
-as wbcs are counted rbc precursors (nrbs only) are counted and classified by stage also

Determine M:E ratio

-Ex: 300 wbc differential and 75 nrbcs were noted
*M:E ratio = 300:75 or 4:1
*Reference range: 3:1 to 4:1

Question 7

Nurse Cell

Answer 7

macrophage surrounded by a ring of maturing erythroid cells. It is thought to provide substances important for the growth of the erythroid cells. Together these cells form a structure known as an erythroblastic island.

Question 8

Lymphocytes in marrrow

Answer 8

-few in number
-included in differential
-excluded from the M:E ratio

Question 9

Plasma Cells in marrow

Answer 9

Can comprise up to 5% of wbcs

Question 10

Osteoblast in Marrow

Answer 10

-bone forming cell
-most resembles a plasma cell
*slightly larger
*nucleus so eccentric as to appear almost extruded
*halo separate from nucleus

Question 11

Identify

Answer 11

Osteoblast

Question 12

Prussian Blue stain on Bone marrow

Answer 12

-3-6 iron laded macrophages(nurse cells) / lpf
-rbc precursors
*normally 20 - 50% of rbcs will contain
some iron granules
*siderocyte - nonnucleated rbc with Fe granules
*sideroblast - nucleated rbc with Fe granules
*increased siderocytes or ringed sideroblasts may be an indication of a sideroblastic anemia

Question 13

Identify

Answer 13

Prussian Blue stain of bone marrow

Question 14

Identify

Answer 14

Sideroblasts in Prussian blue stained iron surrounding rbc nucleus

Question 15

Osteoclast in BM

Answer 15

-responsible for bone reabsorption
-most resembles a megakaryocyte
*it is multinucleated and nuclei are very round and clearly separate from one another

Question 16

What should normal Bone Marrow reference ranges show

Answer 16

A higher concentration of the more mature cells in the lineages.

Question 17

Identify

Answer 17

Osteoclast

Question 18

Mast Cell in bone marrow

Answer 18

-Morphology similar to blood basophils

-Has been determined to arise from a separate stem cell line

Increased in
*chronic infections
*autoimmune diseases
*systemic mastocytosis

Question 19

Identify

Answer 19

Mast Cell

Question 20

Allogeneic BM Transplant Process

Answer 20

Donor
-Collection from BM or Blood
-Processing to purify and concentrate stem cells
-Cryopreservation - to preserve it
-Chemotherapy - prep patient
-Reinfusion into recipient

Question 21

3 ways to donate Bone marrow

Answer 21

Bone marrow
Peripheral blood donation
Cord Blood