Bone Marrow Examination

1. Dr. Aye Aye Tun
Pathology Unit, Faculty of Medicine
RCMP, UniKl

2. Purpose
1. To confirm the diagnosis
2. To assess the response to the
treatment
3. To obtain the specimen for
microbiological examination
4. To obtain the specimen for research
5. To obtain the aspiration of bone
marrow for transplantation

3. Types
1. Bone marrow aspiration
2. Bone marrow trephine biopsy

5. Bone marrow aspiration
1. Leishman's stain
2. Special stain for iron stores
Iron stain (Perl's Prussian blue reaction)
presence of ironbluish green area
3. Cytochemical stain
4. Immunocytochemical stain

6. Prussian blue stains of bone marrow aspirates in
normal (left) and iron-deficiency states (right)

7. Bone marrow trephine biopsy
1. Haematoxylin and Eosin stain
- histological examination
2. Histochemical stain
3. Immunohistochemical stain

8. Advantages of BM aspiration
1. Simple
2. Safe
3. Relatively painless
4. Can be repeated many times
5. Can be performed at OPD
6. Morphology of haemopoietic cells
can be simply identified.

9. Disadvantages
1. The arrangement of the cells in the
marrow and the relationships between
one cell and another are more or less
destroyed by the process of aspiration
2. Fibrotic marrow and highly cellular
marrow → Dry tap

10. Advantages of Trephine biopsy
1. Can provide a perfect view of the
structure of relatively large pieces of
marrow
2. Superior to BM aspiration in some
circumstances e.g. for diagnosing
marrow involvement by malignant
lymphomas or non-haematological
neoplastic diseases

11. Both BM aspiration and Trephine biopsy
have an important and complementary role.

12. Sites
1. Sternum
2. Iliac spines (PSIS)
3. Spinous process (Lumbar vertebrae)
4. Heel (Children)

13. BM Aspiration Needle
• 1. Salah and Klima needle
• 2. Islam needle

14. Salah and Klima needleSalah and Klima needle

15. Islam's bone-marrowIslam's bone-marrow
aspiration/trephine needleaspiration/trephine needle

16. Bone marrow films
1. Direct smear preparation
2. Concentration of BM by centrifugation
(Poorly cellular samples)

17. Examination of BM film
1. BM fragments and cellularity
2. Erythropoiesis
3. Leucopoiesis
4. Megakaryopoiesis
5. M:E Normal 3-4:1 (15:1)
6. Presence of foreign cells
7. BM iron stain (Perl’s Prussian blue)

20. normal bone marrow at medium magnification

21. normal bone marrow at medium magnification

22. normal bone marrow at medium magnification

23. Bone Marrow Biopsy
Markedly hypocellular marrow which is largely devoid of
hematopoietic cells and contains mainly fat cells, fibrous
stroma, scattered lymphocytes and plasma cells

24. A - a markedly hypocellular bone marrow (<5%cellularity)
B - approximately 40% cellularity
C - bonemarrow with nearly 100% cellularity

26. normal bone marrow smear
erythroid precursors
granulocytic precursors

27. Marrow smear from a patient with hemolytic anemia
ERYTHROID HYPERPLASIA
The marrow reveals greatly increased numbers of maturing
erythroid progenitors (normoblasts)

28. Marrow smear from a patient with anemia
Megaloblasts in various stages of differentiation.
granulocytic precursors
Orthochromatic megaloblast