| Preparations which can be made from the bone marrow aspiration specimen include: | View Page |
| Which of the following statements are FALSE regarding the bone marrow BIOPSY specimen? | View Page |
| A biopsy containing 80% fat and 20% cells would be considered: | View Page |
| Collection of the Aspirate 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 of marrow particles and blood from marrow sinuses is withdrawn.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. | View Page |
| Fixation and Processing of the Biopsy Specimen The biopsy specimen is usually fixed in Zenkers’ acetic solution (5% glacial acetic acid; 95% Zenkers) for 6-18 hours or B-5 fixative for one to two hours. Excessive time in either fixative makes the tissue brittle, then briefly decalcified.
The tissue is processed together with other tissues, and is embedded in paraffin and cut at 4 µm and stained with hematoxylin and eosin (H&E) and Perls’ Prussian blue iron stain, and other special stains as indicated. | View Page |
| Advantages of a Biopsy Specimen Examining the biopsy allows the structure of the marrow to be viewed as it exists in the body. It provides essential diagnostic information in conditions that disrupt the normal architecture, such as metastatic carcinoma, myelofibrosis, Hodgkin's lymphoma and granuloma. A biopsy may also be used to evaluate cellularity and identify acid-fast bacteria or fungi in less time than is needed for routine culture methods. One disadvantage of the tissue sections prepared from the biopsy sample is that morphologic detail is lost. For this reason, in many cases imprint slides or smears from the aspirated sample are also examined. | View Page |
| The most common site for bone marrow biopsy and aspiration in adults is: | View Page |
| Match the phrase with its description. | View Page |
| Which of the following statements are TRUE regarding biopsy specimens? (Choose ALL of the correct answers) | View Page |
| Preparation of Direct Smears The sample in the first syringe is quickly delivered into a watchglass or onto a slide. After the technologist verifies the presence of white-gray marrow particles in the sample, push smears and/or coverslip smears from this unanticoagulated sample are made immediately. All films should be rapidly air dried. The appearance of fat as irregular holes in the films also give the assurance that marrow and not just blood has been obtained. This type of smear is referred to as a direct smear and is usually used to evaluate morphology. Although some evaluation of cellularity and M:E ratio is possible, particle smears or biopsy sections provide a more accurate representation of these factors. | View Page |
| Collection of Bone Marrow Biopsy A bone marrow biopsy involves removing a small portion of the bone marrow without destroying the architecture of the marrow. This type of biopsy is necessary when the marrow cannot be aspirated (dry tap) due to a disease process, and also provides additional information complementary to that derived from the aspirate: biopsy specimens are more accurate for assessing cellularity, and infiltrative processes, such as metastatic carcinoma, fibrosis, amyloid, and lymphoma. A biopsy specimen is processed as follows: touch preparation tissue section | View Page |
| Biopsy Touch Preparation A touch prep is made by holding the biopsy plug with a forceps and touching the plug to one or more clean slides in several places. Imprints of the marrow remain on the slide. The slides are quickly air dried, fixed with methanol and stained with Wright-Giemsa or other cytochemical stains. Morphologic details of the cells are preserved with this type of preparation. | View Page |
| Low Power View of Prussian Blue Stained Biopsy This low power view is from a biopsy of a patient with normal iron stores. Note the presence of iron shown by the arrow. | View Page |
| Another Biopsy Showing Normal Iron Stores Another view of a biopsy showing normal amounts of iron. | View Page |
| Increase Marrow Iron Stores Markely increased stainable iron is present in this biopsy. Iron stores may be increased in sideroblastic anemia, chronic infections, hemochromatosis, hemosiderosis due to numerous blood transfusions, chronic hepatitis, cirrhosis, and uremia. | View Page |
| Biopsy Section and Bone Marrow Smear The biopsy section and bone marrow smear can both be used for evaluating iron stores. If the biopsy section is used, the fixative chosen for processing the specimen should not contain acid. Acid fixative can remove iron from the tissue, producing the false impression of iron deficiency. | View Page |
| Microscopic Evaluation of Marrow Smears The microscopic examination of marrow smears can be divided into three main steps.Evaluating cellularity from the biopsy/particle smearEvaluating marrow iron from the biopsy/particle smearMorphology examination from the Romanwsky stained smears | View Page |
| Medium Power View of Biopsy This biopsy also has a cellularity of 25% and approximately 75% fat, and is therefore slightly hypocellular. | View Page |
| The peripheral blood platelet count in this patient will likely be: | View Page |
| Evaluating Cellularity The biopsy section or particle smears are the preparations that are preferred for the evaluation of marrow cellularity and architecture. The low power objective is used to examine the slide and compare the cellular area to the amount of fat (fat cells appear as white circles interspersed among the cellular elements). On the biopsy section the specific type of cells present are difficult to determine but the cellularity can be clearly seen. The particle smear may be used to evaluate cellularity as well as morphology. The diagnostic significance of the evaluation of cellularity, is simply to see if there are too few, too many, or sufficient cell precursors present in the bone marrow. | View Page |
| Hypocellular Bone Marrow Biopsy This biopsy section was taken from a patient who has very few cellular elements in the marrow. Notice that over 90% of the marrow is composed of fat. If all of the cellular elements are decreased, the patient's condition is said to be pancytopenic or aplastic. There are numerous causes for aplasia, including drugs such as chloramphenicol, chemotherapy and inheritance (Fanconi's Anemia). | View Page |
| Low Power View of Biopsy This low power view of a hematoxyln and eosin stained bone marrow biopsy shows fat cells as clear circles, and the darker intervening areas as blood cell precursors. This biopsy is about 25% cellular, or mildly hypocellular. A normal marrow in a middle aged adult is about 50% cellular. | View Page |
| Hypercellular Bone Marrow Biopsy This is another view of the same slide showing increased cellularity and decreased fat. | View Page |
| Hypercellular Bone Marrow Biopsy A low power view of a biopsy section stained with hematoxylin eosin stain. This section is showing increased cellularity and decreased fat. This specimen is about 85% cellular. | View Page |