Bone Mar row Patholog y

1 t r a P

R.S. Riley , M.D., Ph .D.

Bone Marrow Pathology

Bone marrow basics Red cell diseases White cell diseases Other diseases

Bone Marrow Pathology

Bone marrow basics
Hematopoiesis Bone marrow structure Obtaining bone marrow Interpreting bone marrow

Red cell diseases White cell diseases Other diseases

Bone Marrow Pathology

Bone marrow basics
Hematopoiesis Bone marrow structure Obtaining bone marrow Interpreting bone marrow

Red cell diseases White cell diseases Other diseases

Dont Worry! This Wont Hurt A Bit!!

Reich, C. A Clinical Atlas of Sternal Bone Marrow Abbott Laboratories, 1946

Indications for Bone Marrow Examination

Major Indication Diseases
Unexplained cytopenia Acute leukemia Chronic leukemia Myelodysplastic syndrome Myeloproliferative disease Plasma cell dyscrasia Non-Hodgkin lymphoma Hodgkin lymphoma Aplastic anemia Fever of unknown origin Small cell tumors of childhood Mast cell disease Disseminated granulomatous disease Thrombotic thrombocytopenic purpura Primary amyloidosis Metabolic bone disease Chemotherapy/bone marrow transplantation Treatment of isolated cytopenia

Disease diagnosis

Therapeutic follow-up

Rileys Hints and Tips

Get appropriate patient information first Indications, past history Get proper consent! Beware of hostile, combative patients - Dont risk your life! Always ask about allergies and bleeding problems Never talk a patient out of getting premedication Keep up a conversation with the patient during the procedure Make sure the patient remains still Remain calm, no matter what happens Make sure post-procedure care is understood Always carry the tray for Eileen!

Bone Marrow Preparations

Preparation Particle crush smear Cover slip preparations Direct aspirate smears (Wedgies) Buffy coat smears Biopsy imprints (Touch preps) Clot sections Procedure Particles placed between slides, pulled apart Most accurate reflection of bone marrow morphology Particles placed between coverslips, pulled apart Good for cytochemical staining Particles placed on slide, spread with another slide Easiest smear preparation technique Anticoagulated aspirate, cells concentrated with buffy coat, no red cells, excellent morphology Slide gently touched to biopsy core, poor pathologists bone marrow aspirate Aspirate clotted by adding thrombin, submitted as tissue block Fixed, decalcified, processed embedded in paraffin or plastic, sectioned H&E stain, PAS, etc. (except iron stain)

Biopsy core

Bone Marrow Aspirate & Biopsy

Bone Marrow Aspirate

Bone Marrow Biopsy

Bone Marrow Clot Section

Numbing Skin

Numbing Bone

Bone Marrow Aspirate

Making Aspirate Smears

Making Aspirate Smears

Bone Marrow Biopsy

Bone Marrow Biopsy

Touch Preparations

Finishing Up

Bone Marrow Harvest

What are the contraindications to the bone marrow examination?

1. Lack of good medical indication 2. Lack of informed consent

Complications of Bone Marrow Examination

Complication
Bleeding

Comment
Hematoma most common complication Beware of patients with coagulopathies! Rarely serious, topical medication, post-procedure care Very rare, usually lateral cutaneous nerve, mostly obese patients Older individuals, no specific signs or symptoms Very rare, requires systemic therapy Osteopetrosis, may require operative removal Very rare, retroperitoneal hemorrhage

Wound infection

Neuropathy Fracture Osteomyelitis Needle breakage Death