CASE 1

 A 23 years old lady presented with complaints of feeling unwell for 3 days, associated with fever and
gum bleeding.
 Her Full Blood Count is as follows:

Hb 9.2g/dL
WBC 40x 109/L
PLT 40 x 109/L

 An urgent PBF was requested.

 What is your preliminary
diagnosis
Acute Myeloid Leukaemia
CASE 2

 A 34 years old gentleman presented with gum bleeding and bruises. He appears pale and weak. His
Full Blood Count findings are as below.
 Hb 5 g/dL

 WBC 1.5 x 109/L

 Plt 5x109/L
Acute Promyelocytic Leukaemia
CASE 3

 A 5-day old baby boy was noted to have jaundice. Screening tests reveal that he is G6PD deficient.
Acute Oxidative Haemolysis
BONE MARROW EXAMINATION

 Bone marrow examination is useful in the diagnosis and staging of hematologic disease and
assessment of overall bone marrow cellularity
 Because of easy accessibility, aspiration, biopsy, and culture of the bone marrow may also play a
role in the assessment of patients with fever of undetermined origin as well as in the diagnosis of
various storage and infiltrative disorders
BONE MARROW EXAMINATION

Bone Marrow Aspirate Bone Marrow Biopsy (Trephine

Biopsy)
To look at cell morphology, better Best for assessment of marrow
modality to appreciate dysplasia cellularity, patchy bone marrow
infiltration by malignancy, dry tap

MGG stain, special stains to assess specimen in formalin for fixation

iron stores (Perl stain), H&E stain, imunohistochemical
cytochemical stains eg. stains
peroxidase
Dry tap if marrow fibrosis or marrow Able to identify fibrosis by reticulin
infiltration present stain
BONE MARROW
ASPIRATE
BONE MARROW
BIOPSY (TREPHINE
BIOPSY)
BONE MARROW BIOPSY SITE

 The iliac crest - only site at which aspiration

and biopsy may be safely performed in the
adult
 The posterior superior iliac crest and spine is
the favored site of examination - least
discomfort to the patient
 The anterior iliac crest may be used for bone
marrow aspiration and biopsy in adults when
access to the posterior iliac crest is limited
 In premature and some full-term infants the
anterior portion of the tibia should be used
BONE MARROW EXAMINATION

Contraindications
 severe hemophilia, severe disseminated intravascular coagulation, or other related severe bleeding
disorders.
 Thrombocytopenia is not a contraindication

Complications
 Complications of bone marrow aspiration/biopsy are rare

 Include pain, discomfort,and/or bleeding at the site of the procedure

BONE MARROW EXAMINATION

Assessment of:
 Fragments and cellularity
 Haemopoiesis – erythropoiesis, granulopoiesis, megakaryopoiesis

 M:E ratio (myeloid: erythroid)

 Abnormal cells
 Iron stores (Perls stain)

 Other tests: cultures, genetics testing, flowcytometry

 THANK YOU
 Helpful references: Essential Haematology, AV Hoffbrand
 Images used in this presentation belong to the respective owners. No copyright infringement is
intended.
 Questions may be directed to: CarolineHo.SiewLing@monash.edu