Bone marrow biopsy

Keywords: BM biopsy

Specimen:

Collected by pathologist.

Marrow aspirate: films for morphology, and when indicated, specimens for Cell immunophenotyping (Flow cytometry), Cytogenetics, Molecular genetics, bacterial culture (including AFB).

Trephine: biopsy placed in appropriate fixative, decalcified and processed as a histopathological specimen.

Method:

Needle aspiration and trephine are taken nearly always from the posterior iliac crest.

In children, the specimen may be collected from the tibia.

Bone marrow aspirate only rarely taken from the sternum in adults in exceptional circumstances by experienced proceduralist.

Application:

Assessment of underlying cause of abnormal Full blood count and/or Blood film, if appropriate.

Diagnosis, staging and progress of leukaemias, Myelodysplastic syndromes, Myeloproliferative neoplasms, myeloma, lymphomas.

Investigation of Leucoerythroblastic anaemia; possible bone marrow infiltration with metastatic carcinoma, amyloid, granulomatous disorders.

Required for diagnosis of Sideroblastic anaemia.

Assessment of whether reduced cell numbers are due to failure of production or peripheral destruction; diagnosis of marrow hypoplasia or aplasia.

Occasionally useful for the diagnosis of infection, eg, Mycobacterial infection, Typhoid, Brucellosis.

Rarely indicated for the investigation of Lysosomal storage disease.

See also Cell immunophenotyping, Flow cytometry, Cytogenetics - oncology, Molecular genetics and Cytochemistry.

Interpretation:

Report by pathologist. Assessment of haemopoiesis, including morphology of haemopoietic cells. Detection and identification of abnormal cells and diagnosis of bone marrow infiltration.

Reference:

Bain BJ et al. Bone Marrow Pathology. 2nd ed. London: Blackwell Science, 1996.

Brunning RD, McKenna RW. Tumors of the Bone Marrow. Atlas of Tumor Pathology. 3rd series, Fascicle 9. Washington DC: AFIP, 1994.