Ch. 16 Bone Marrow Examination Flashcards by Arvee Perez

Collab bet. medtedch and a physician (hematologist or pathologist)

Bone marrow specimen collection

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Collected, prior to bm collection, for a CBC w/ blood film exam

Peripheral Blood

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Gelatinous and amenable to sampling

Red marrow

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Composition of a Bone Marrow specimen

1) Aspirate

2) Core Biopsy Specimen

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obtained by BM aspiration

aspirate

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obtained by trephine biopsy

Core Biospy Specimen

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examined to identify the types and PROPORTIONS OF HEMATOLOGIC CELLS and to look for MORPHOLOGIC VARIANCE

Aspirate

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demonstrates BM architecture, spatial relatinshp of hematologic cells to fat, CT, bony strome

Core Biopsy Specimen

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used to estimate CELLULARITY

Core Biopsy Specimen

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particularly important for evaluating DISEASES that characteristically produce FOCAL LESIONS rather than diffuse involvement of marrow.

Core Biopsy specimen

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diseases that produce predominantly FOCAL LESIONS

Hodgkin lymphoma
non-Hodgkin lymphoma
multiple myeloma
metastatic tumors
amyloid
granulomas

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cell accumulations that contain Langerhans cells

Granulomas or Granulomatic Lesions

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are large, activated granular macrophages that look like epithelial cells

Langerhans Cells

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Granulomas signal _____ infection

Chronic infection

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Biopsy Sx allows morphologic evaluation of bony spicules, which may reveal changes associated with ____

hyperparathyroidism or Paget disease

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this site of BM collection provides adequate red marroow that is isolated from anaomic structures wc are subject to INJURY

Posterior superior iliac crest

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same as post. iliac crest but cortical bone is THICKER

Anterior iliac crest

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BM site used for BOTH aspirate and core biopsy

Posterior iliac crest

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BM site used for a patient who can ONLY lie SUPINE

Anterior iliac crest

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below the angle of Lewis at 2nd intercostal space
This provides AMPLE material for Aspiration
Can accidentally damage the heart or great vessels if needle enters the PERICARDIUM

Sternum

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only 1 cm thick and cannot be used for core biopsy

Sternum

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BM site for CHILDREN younger than age 2

Anterior medial surface of the tibia

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BM sites that are RARELY used unless they are the site of a suspicious LESION discovered on radiograph

Spinous process of the vertebrae, ribs or other Red Marrow containing bones

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most common side effect to anesthetics during BM collection

Hemorrhage associated with thrombocytopenia

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When does the medtech collects VENOUS PERIPHERAL BLOOD prior to bone marrow collection

Less than 24 hrs

Effect on WBC count if peripheral blood is collected after BM collection

elevated (stress)

Usual local anesthetic injection

1% lidocaine (not to exceed 20 mL per patient)

blade used for skin incision

No. 11 scalpel blade

Disposable needles that provide an OBTURATOR, CORE BIOPSY TOOL, and STYLET

1) Jamshidi biopsy needle | 2) Westerman-Jensen needle

Biospy needle that has a COIL MECHANISM at the needle tip which allows capture of BM Sx without needle redirection

Snarecoil needle

gauge of BM aspiration needle

14-18

provided to prevent penetration of the sternum to the pericardium

Flange

fixative used in BM collection

Zenker fixative

Position of Patient during BM collection

Pt. lies in a supine position, prone, or in a decubitus position

what part of bone surface is the papule located

Periousteum

mm of skin incision over the puncture site

3-mm

Which specimen is usually collected first to prevent destruction of marrow architecture

Core Biopsy Specime

this part of the needle prevents coring of the skin or bone

Obturator

Where is the needle pentrated

through the Cortex to the medulla

dislodges the core cylinder (where the Sx is located) after BM core biopsy collection

stylus

Jamshidi needle parts

1) outer cannula 2) obturator 3) biopsy needle 4) core cylinder 5) stylus

Westerman-Jensen needle parts:

1) needle/ outrer cannula 2) obturator 3) cutting blades

Aspirating more than 1.5 mL dilutes the hematopoietic marrow with

sinusoidal (peripheral) blood should only collect 1-1.5mL

Term used if there's Unsuccessful aspiration bc the marrow is FIBROTIC, acellular, or packed with Leukemic cells

Dry Tap

this is applied to the patient while he remains in the same position for 1 hr to prevent bleeding

Pressure Dressing

More spicules recovered in the blood smear meaning _____. | Few fat globules or spicules meaning _____.

More cells to identify and categorize. Physician to collect an additional specimen.

These specimens are more leisurely alternative to direct aspirate smears

Anticoagulated specimens

anticoagulant used with Aspirate smears. It generates the least distortion of cell morphology.

K3EDTA

What is added after crush smearing and the Sx is suspected to contain POLYLYMPHOCTES or LYMPHOBLASTS which tend to rupture

22% albumin

reduces the occurrence of "smudge" or "basket" cells often seen in lymphoid marrow lesions

Albumin

This crush preparation procedure method yields better MORPHOLOGIC INFORMATION bc theres less cell rupture during separation

Cover-slip method

Used in automated staining after smearing

Glass slide method

Crush smear prep where smear must be affixed side up to slide first and then stained manually

COVERSLIP PREPARATION

The cell morphology of these preparations may imitate aspirate morphology. They are valuable when the specimen has clotted or theres a dry tap.

Imprint or Touch Preparationos

smears that are useful when there are sparse NUCLEATED CELLS in the direct marrow smear or when the number of nucleated cells is anticipated to be small, like APLASTIC ANEMIA

Concentrate or Buffy coat smears

1st layer in Wintrobe tube after centrifugation

Yellowish fat (1-3% of Wintrobe column)

2nd Layer in Wintrobe tube after centriguation

Plasma

3rd layer in Wintrobe tube after centriguation

Nucleated cells or "MYELOID-ERYTHROID LAYER" (ME Layer) | normally 5-8% of total column

4th/ Bottom Layer in Wintrobe tube after centriguation

Red Blood Cells

recorded using mm graduations on Wintrobe tube

fat/ME layer ratio

portion of ME layer + portion of plasma >> in a Petri dish/watch glass =

Concentrate (buffy coat) smear

This smear compensates for hypocellular marrow and allows for examination of large numbers of nucleated cells without interference from FAT and RBCs

Concentrate (buffy coat) smear

This procedure destroys cell distribution. thus, DO NOT estimate nos. of diff. cell types or maturation stages on this smear

Concentrate (buffy coat) smear

Where the remaining core bioppsy specimens, spicules or clottes sx are submitted to after aspirates mears are prepared

HISTOLOGIC SECTIONS (Cell Block)

In histologic exam, the specimen is suuspended in _____ fixative for 2 hours

10% formalin or Zenker glacial HAc or B5 fixative

IIn histologic exam, what dyes are used after sectioning the embedded specimen

Hematoxylin & Eosin (H&E) dye

Marrow Aspirate Smear dyes used

Wright or Wright Giemsa dyes

In this smear prep, there's Increased staining time because thicker smear than Peripheral Blood Smear

Marrow Aspirate Smear

Stain that can be used for MARROW ASPIRATE SMEARS and CORE BIOPSY SPECIMENS to detect and estimate MARROW STORAGE IRON or IRON METABOLISM ABNORMALITIES

Ferric Ferricyanide (Prussian blue)

Cytochemical Dye used to detect MYELOCYTIC CELLS by staining CYTOPLASMIC GRANULAR CONTENTS

1) Myeloperoxidase (MPO) | 2) Sudan Black B (SBB)

Cytochemical Dye used to detect LYMPHOCYTIC CELLS and certain ABNORMAL ERYHTROCYTIC CELLS by staining of CYTOPLASMIC GLYCOGEN

Periodic acid Schiff (PAS)

Cytochemical Dye used to distinguish MYELOCYTIC from MONOCYTIC MATURATION STAGES (several ESTERASE substrates)

Esterases

Cytochemical Dye used to detect TARTRATE-RESISTANT ACID PHOSPHATASE GRANULES in HAIRY CELL LEUKEMIA

Tartrate-resistant acid phosphatase (TRAP)

(BM Aspirate Microscopic smear exam) PROCEDURES IN LOW POWER: 10x Obj

PeBoRaTuMe 1) Assess PERIPHERAL BLOOD DILUTION 2) Find BONY SPICULES and areas of CLEAR cell MORPHOLOGY 3) Observe fat-to-marrow RATIO, estimate CELLULARITY 4) Search for TUMOR cells in Clusters 5) Examine and estimate MEGAKARYOCYTES

(BM Aspirate Microscopic smear exam) PROCEDURES IN HIGH POWER: 10x Obj

MemAbMaDiffME 1) observe MYELOCYTIC and ERYTHROCYTIC MATURATION 2) distinguish ABN. DISTRIBUTION OF CELLS or CELL MATURATION STAGES 3) perform DIFF COUNT on 300-1000 cells 4) compute MYELOID-ERYTHROID RATIO (M:E)