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Dr. Aye Aye Tun
Pathology Unit, Faculty of Medicine
RCMP, UniKl
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
Types
1. Bone marrow aspiration
2. Bone marrow trephine biopsy
Bm examination
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
Prussian blue stains of bone marrow aspirates in
normal (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 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.
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
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
Both BM aspiration and Trephine biopsy
have an important and complementary role.
Sites
1. Sternum
2. 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 needleSalah and Klima needle
Islam's bone-marrowIslam's bone-marrow
aspiration/trephine needleaspiration/trephine needle
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)
Bm examination
Bm examination
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 of
hematopoietic cells and contains mainly fat cells, fibrous
stroma, scattered lymphocytes and plasma cells
A - a markedly hypocellular bone marrow (<5%cellularity)
B - approximately 40% cellularity
C - bonemarrow with nearly 100% cellularity
Bm examination
normal bone marrow smear
erythroid precursors
granulocytic precursors
Marrow smear from a patient with hemolytic anemia
ERYTHROID HYPERPLASIA
The marrow reveals greatly increased numbers of maturing
erythroid progenitors (normoblasts)
Marrow smear from a patient with anemia
Megaloblasts in various stages of differentiation.
granulocytic precursors
Orthochromatic megaloblast

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Bm 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
  • 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