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

Bone marrow aspiration

1. Leishman's stain
2. Special stain for iron stores
Iron stain (Perl's Prussian blue reaction)
presence of ironbluish 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 needle

Islam's bone-marrow aspiration/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 (Perls 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 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

granulocytic precursors

erythroid precursors

normal bone marrow smear

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

granulocytic precursors

Orthochromatic megaloblast

Megaloblasts in various stages of differentiation.