Aspiration Information and Courses from MediaLab, Inc.

Spinal fluid samples are either clear or turbid. Some sources use the following rating system for turbid CSF specimens: 0 = crystal clear fluid 1+ = faintly cloudy, smoky, or hazy 2+ = turbidity clearly visible but newsprint read easily through tube 3+ = newsprint not easily read through tube 4+ = newsprint cannot be seen through the tubeTurbidity may be caused by leukocytes, erythrocytes, fungi, bacteria, amoebae, contrast media, or aspiration of epidural fat during puncture.200 leukocytes/mm3 will cause slight turbidity (1+); increased numbers of WBCs will cause increased turbidity. At least 400 erythrocytes/mm3 are needed to produce 1+ turbidity.Occasionally CSF will have an oily appearance due to the presence of substances remaining in the CSF after radiologic (x-ray) procedures have been performed.

The marrow aspiration is usually performed before a biopsy is done. A syringe is attached to the needle, the plunger is pulled and 1.0-1.5 ml. of marrow particles and blood from marrow sinuses is withdrawn. If additional bone marrow samples are needed, a separate syringe must be used each time. If more than 2 cc. per syringe is taken out, the blood to marrow ratio will be too high and the preparations will not accurately reflect the marrow contents. As the marrow is aspirated into the syringe the patient will feel some pain and pressure even though local anesthetic has been administered.

This slide shows a marrow aspiration smear with numerous ring sideroblasts. Normal red cell precursors have only one or at most two granules of iron in their cytoplasm. These abnormal red cell precursors have numerous iron containing granules in their cytoplasm indicating abnormal iron incorporation. This iron is actually incorporated into mitochondria. Ring sideroblasts can be seen in idiopathic sideroblastic anemia, and in sideroblastic anemia induced by drugs, lead poisoning, and alcohol abuse.