Chapter 2 - Bone marrow examination and interpretation

Abstract

Complete blood count, as well as review of peripheral blood smear, may not provide an unambiguous diagnosis of hematological or nonhematological disease in certain patients. For these patients, direct microscopic examination of the bone marrow is essential for diagnosis. The bone marrow that is disseminated within the intertrabecular and medullary spaces of bone is a complex organ with dynamic hematopoietic and immunological function. Today, with development of newer techniques and equipment, bone marrow aspirate and bone marrow biopsy have become an important medical procedure for diagnosis of hematological malignancies and other diseases and also for follow-up evaluation of patients undergoing chemotherapy, bone marrow transplantation, and other forms of therapy. Cytochemical analysis and various other diagnostic procedures can be performed on the liquid bone marrow aspirate, while bone marrow biopsy can be stained using immunoperoxidase and other stains. During a routine bone marrow examination, slides obtained from the aspirate, slides obtained from the clot sections, slides from the trephine biopsy, touch preparation slides obtained from the trephine biopsy, and iron strains must be carefully examined for proper interpretation of results. Various aspects of bone marrow examination and pitfalls are addressed in this chapter.