Purpose1. To confirm the diagnosis2. To assess the response to thetreatment3. To obtain the specimen formicrobiological examination4. To obtain the specimen for research5. To obtain the aspiration of bonemarrow for transplantation

Types

1. Bone marrow aspiration

2. Bone marrow trephine biopsy

Bone marrow aspiration

1. Leishman's stain

2. Special stain for iron storesIron stain (Perl's Prussian blue reaction)presence of ironbluish green area

3. Cytochemical stain

4. Immunocytochemical stain

Prussian blue stains of bone marrow aspirates innormal (left) and iron-deficiency states (right)

Bone marrow trephine biopsy

1. Haematoxylin and Eosin stain

- histological examination

2. Histochemical stain

3. Immunohistochemical stain

Advantages of BM aspiration1. Simple2. Safe3. Relatively painless4. Can be repeated many times5. Can be performed at OPD6. Morphology of haemopoietic cells can besimply identified.

Disadvantages1. The arrangement of the cells in themarrow and the relationships betweenone cell and another are more or lessdestroyed by the process of aspiration

2. Fibrotic marrow and highly cellularmarrow Dry tap

Advantages of Trephine biopsy1. Can provide a perfect view of thestructure of relatively large pieces ofmarrow2. Superior to BM aspiration in somecircumstances e.g. for diagnosing marrowinvolvement by malignant lymphomas ornon-haematological neoplastic diseases

Both BM aspiration and Trephine biopsyhave an important and complementary role.

Sites1. Sternum2. Iliac spines (PSIS)3. Spinous process (Lumbar vertebrae)4. Heel (Children)

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

Salah and Klima needle

Islam's bone-marrow aspiration/trephineneedle

Bone marrow films

1. Direct smear preparation

2. Concentration of BM by centrifugation

(Poorly cellular samples)

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)

normal bone marrow at medium magnification

normal bone marrow at medium magnification

normal bone marrow at medium magnification

Bone Marrow Biopsy

Markedly hypocellular marrow which is largely devoid ofhematopoietic cells and contains mainly fat cells, fibrousstroma, scattered lymphocytes and plasma cells

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

normal bone marrow smear

erythroid precursors

granulocytic precursors

Marrow smear from a patient with hemolytic anemia

ERYTHROID HYPERPLASIAThe marrow reveals greatly increased numbers of maturingerythroid progenitors (normoblasts)

Marrow smear from a patient with anemia

Megaloblasts in various stages of differentiation.

granulocytic precursors

Orthochromatic megaloblast