Bone Marrow Analysis

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Subject: Bone Marrow Analysis

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Definition

  • Bone marrow analysis refers to studies of an aspirate or/and a biopsy with the objective of obtaining marrow samples. The bone marrow is usually obtained from the posterior iliac crest. The test is indicated when abnormalities in the peripheral blood are found that require additional etiologic, classification and prognostic details. The procedure can be performed at the bedside or in the office.

  • Normal range: Cellularity-to-fat ratio is 100% at birth and declines ≈10% each decade; 9:1 in young children; 2:1 in young adults; 1:1 in middle-aged adults; gradually decreases to 1:9 in the elderly. Differential distribution tables of the various hematopoietic lineages can be found in hematology and pathology textbooks.

Use

  • Bone marrow aspirates are used for their excellent cellular morphologic maturation and definition of cellular abnormalities, cytochemistry, cytogenetic studies, molecular studies, flow cytometry, microbial culture and identification, occasionally electron microscopic studies, and tissue culture. Aspirates can also be used for bone marrow transplantation, where large amounts of marrow need to be collected. (Concentrated peripheral blood stem cells are now used in most cases for this purpose.)

  • Bone marrow biopsies are useful for examination of intact marrow tissue and overall cellularity, histochemistry, and immunohistochemistry, as well as for certain molecular diagnostic tests. Biopsies are excellent for evaluating iron stores, fibrosis, granulomas, abscesses, metastases, and vascular lesions.

  • Bone marrow is studied to diagnose or follow-up various conditions that may affect it or infiltrate it.

    • For the diagnosis of anemia of iron deficiency bone marrow iron stains are the gold standard; also helpful in some cases of iron overload

    • Neoplasms that originate in or infiltrate the marrow: leukemias, myeloproliferative neoplasms, myelodysplastic syndromes, plasmacytic neoplasms, metastases; amyloidosis

    • Staging of Hodgkin and other lymphomas

    • Tumors and infections (e.g., TB) that invade the marrow and result in leukoerythroblastic peripheral blood picture (myelophthisic anemia)

    • Aplastic anemia, agranulocytosis, cytopenias

    • Unexplained anemia, splenomegaly, lymphadenopathy

    • Megaloblastic anemias (rarely necessary)

    • Exposure to drugs resulting in bone marrow damage

    • Follow-up therapy for leukemias, lymphoma (in cases that present with bone marrow infiltration), myelodysplastic and myeloproliferative neoplasms

    • Monitoring recovery following stem cell transplantation and marrow-ablative therapy

    • Infectious diseases and fever of unknown etiology (cultures, organism identification)

Limitations

  • Bone marrow aspirate may be diluted with peripheral blood and contain too few cellular elements.

  • Bone marrow biopsy may have insufficient tissue for accurate diagnosis; the underlying condition may result in patchy infiltrations of the marrow (e.g., myelomas), and the pathology may be missed.

 
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