Bone Marrow Aspirates Flashcards
In what cases would you required a bone marrow aspirate?
Unexplained…
Non-regenerative anemia Neutropenia Thrombocytopenia Suspected neoplasia or monoclonal gammopathy Classify leukemia
What locations can bone marrow be taken from?
Trochanteric fossa of femur
Humerus
Wing of ilium
A bone marrow biopsy needle is ____________ guage
16-22
When looking at a bone marrow aspirate, what characteristics should you assess?
Cellularity Presence of megakaryocytes Presence of iron stores Myeloid:erythroid ratio Orderliness and completeness of maturation
Presence of other cells (i.e. Plasma cells)
Presence of abnormal cells or microorganism
What stain can be used to visualize iron stores present in the bone marrow?
Prussian blue
-> free hemosiderin or hemosiderin in macrophage
What should the M:E ratio be?
1:1 to 3:1 is normal
M=graunulocytes
E=erythrocytes
If you see a M:E ratio of 5:1, what could be your DDX?
Erythroid hypoplasia/aplasia (decrease in RBC)
OR
Granulocytic hyperplasia or leukemia (increase in WBC)
Bone marrow aspirate appears to have a ratio M:E ratio of 25:1
So we do a CBC…
PCV 38%
NCC 96,000
Neutrophil 83,000
Bands 8,000
Monos 5,000
What is your interpretation
Aneimia
CBC shows increased neutrophils in peripheral tissue–» granulocytic hyperplasia or granulocytic leukemia
Bone marrow aspirate with M:E of 1:25
CBC.. PCV 20% NCC 15,000 Neutrophil 12,000 Lymphs 3,000
Interpretation?
Increased numbers of RBC
Neutrophil and lymphs in peripheral tissue are normal so the change in ratio is due to increased RBC
What can be causes of a disorderly maturation of cells in the bone marrow?
- Consumption-> All functional cells are leaving bone marrow to fight infection
- Immune mediated destruction of later stages
- Bone marrow injury (eg chemo or parvo)
- Leukemia -> acute most are immature stages and not maturing
How can plasma cells be differentiated from osteoblasts/osteoclasts in bone marrow
Both have abundant cytoplasm with a peripheral nucleus
Plasma cells–> vacuoles filled with immunoglobulin
Osteoclasts –> rough cytoplasm at edge and are multinucleated
What fungal organism can be found in bone marrow?
Histoplasma
Cryptococcus
Blastomyces
What protozoal organism can be seen in bone marrow
Toxoplasma gondii
Leishmania Donovan I
In macrophage, you see large numbers of round-oval objects that are surrounded by a capsule
Histoplasmosis
Bone marrow aspirate shows banana shaped objects int he cytoplasm
Toxoplasmosis
