Bone marrow results 1

Reza khodadadi

UG: 1701801

Lecturer: DR Tamta
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 Bone marrow is a specialized type of tissue found at the centre of a

bone.
 A bone marrow examination is often performed to look for diseases such as
lymphoma and leukemia.
 A bone marrow pathology report includes information about what a
pathologist saw when they examined the tissue from your bone marrow
sample under the microscope.
 Most bone marrow pathology reports will include information about the
amount and quality of the of the tissue and types of normal bone marrow
cells seen under the microscope.
 Any abnormal cells or changes will also be described.

What is a bone marrow pathology report?

A bone marrow pathology report is medical document prepared for you by
a pathologist. It includes information about what the pathologist saw when they
examined the tissue from your bone marrow sample under the microscope. It may
also include information about additional tests that were performed on the tissue
sample such as flowor immunohistochemistry.

Normal bone marrow

The bone marrow is a specialized type of tissue found at the centre of a bone.
Unlike the outside of a bone, which is very hard, the bone marrow is soft. In
children bone marrow can be found at the centre of most bones. However, as
adults, the bone marrow is typically found in the ribs, sternum, pelvis (hip bones),
and vertebra (back bones).

The bone marrow is where most of your blood cells are produced. These cells
include white blood cells (WBC), red blood cells (RBC), and platelets. The normal
bone marrow is full of developing blood cells, which are surrounded by connective
tissue and fat.

Reasons for examining bone marrow

The best way to see if you bone marrow is healthy and producing normal blood
cells is to examine a sample of tissue under the microscope. Your doctor may also
request a bone marrow examination if you have symptoms that can be caused by a
bone marrow disease or if there is an unexplained change seen in your blood cells.
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There are many types of bone marrow diseases, such as leukemia or diseases that
affect the production of blood cells or platelets. Your bone marrow can also be
involved by lymphoma or plasma cell disorders. Cancers from other parts of the
body can also spread to the bone (this is called a metastasis).

Your bone marrow may also be affected by problems that involve your entire body
such as deficits in nutrients like iron or vitamin B12, infections, and renal disease. In
some cases, your doctor may request a bone marrow examination if abnormal
changes in your blood persist despite treatment or if they suspect there may be a
separate issue involving the bone marrow.

How is a bone marrow examined?

In order to see what is happening inside your bone marrow, your doctor will
remove a small sample of bone marrow. The sample is usually taken from a bone in
the hip. Most samples are taken from an area of the hip bone called the posterior
iliac crest, because it is large and easy to reach with a needle.

There are two types of tests that can be performed to examine bone marrow. Your
doctor may perform one or both types at the same time.

1. Aspirate – An aspirate uses a needle and suction to remove a small amount

of bone marrow. The tissue sample is then spread on a slide so it can be
examined. Spreading the tissue allows your pathologist to examine the size,
shape, and colour of individual cells and count them. Because the sample is
spread onto the slide, it is not possible to see how the cells were organized
inside the bone marrow.
2. Core needle biopsy – A core needle biopsy also uses a needle to remove a
small amount of bone marrow. However, unlike an aspirate, the tissue
sample in a core biopsy is a solid piece of tissue that needs to be cut into thin
sections before it can be examined under a microscope. A core needle biopsy
is better at looking at the organization of the bone marrow and how the cells
stick together. In addition, some diseases cause fibrosis in the bone marrow
which can make it very difficult to aspirate cells. In this situation a core
biopsy is crucial to examine the bone marrow.

When a pathologist examines a bone marrow tissue sample, they first determine if
enough tissue is available to make a diagnosis. They then look for some basic
features that allow them to decide if the tissue is normal or abnormal.
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Below you will find the basic information pathologists usually look for when
examining a bone marrow tissue sample.

Length and quality of the core biopsy

Your pathologist will measure the length of the tissue sample in the core needle
biopsy. Because certain types of diseases may only involve part of the bone
marrow, small tissue samples may miss the area of disease.

Your pathologist will also comment on the quality of the core needle biopsy. For
example, some tissue samples can be crushed during the procedure which will limit
the pathologist’s ability to analyze the cells.

Your pathologist may recommend repeating the biopsy if the tissue sample is too
small or of low quality.

Bone trabeculae
Trabeculae are thin pieces of hard bone that run through the bone marrow. Some
types of disease cause the trabeculae to become thicker or thinner than normal.
For that reason, your pathologist will describe any trabeculae seen in the biopsy
and if they look normal or abnormal.

Quality of the aspirate

A bone marrow aspirate is usually made up of multiple small pieces of tissue and
the quality of the aspirate depends on the number of pieces on the slide. Too few
pieces may prevent your pathologist from making a diagnosis. The aspirate can also
contain a lot of blood (this is called a hemodiluted aspirate) and in some cases may
not be trusted to represent the bone marrow.

Your pathologist may recommend repeating the biopsy if there are not enough
pieces to examine or if there is too much blood.

Cellularity
The bone marrow is made up of both developing blood cells and fat. The number of
cells relative to fat changes as we age. Younger people normally have more cells in
their bone marrows compared to older people who have more fat.

Your pathologist will look to see if the number of cells relative to fat in your bone
marrow is normal for your age or if there is a change in the total amount of cells.
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A change in the total number of cells in your bone marrow can be a sign of a
cancer, a sign that your bone marrow cells are not functioning normally, or a
reaction of the bone marrow to something happening in a different part of your
body. Your pathologist will carefully examine the cells to determine the cause and
may order additional tests if required.

Types of cells normally seen in the bone marrow

Hematopoietic cells
The developing blood cells in the bone marrow are called hematopoietic cells.
There are three main types of hematopoietic cells and each produce a different
group of blood cells. All of the blood cells that come from a single type of
hematopoietic cell are called a “lineage”.

The three lineages of hematopoietic cells are:

1. Erythroid: This is the lineage that produces red blood cells (RBC). Developing
red blood cells are called erythroblasts.
2. Granulocytic: This lineage produces white blood cells such as neutrophils.
Immature granulocytes are called myeloblasts.
3. Megakaryocytic: This lineage produces platelets. Platelets come from large
cells called megakaryocytes.

Cells from all three lineages are found in a normal, healthy bone marrow. Your
pathologist will examine the tissue sample to see if all three lineages are present.
They will also look to see if there is any change in the number of cells from any one
lineage or if any of the developing cells show an abnormal shape or size.
Pathologists use the word dysplasia to describe abnormal looking cells.

Blasts
A normal bone marrow shows a mixture of both developing blood cells and mature
blood cells ready to be released into the blood stream. The most immature cells are
called blasts, and they should only be seen in very small numbers. If your
pathologist sees more developing cells than normal, this is called a “left shift”. If no
mature cells are seen this is called a “maturation arrest”. Both a left shift and
maturation arrest are abnormal, but a left shift can sometimes be a reaction of
your bone marrow to something else happening in your body such as an infection.

Other types of cells

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A normal bone marrow also contains small numbers of other cells

like lymphocytes and plasma cells. Developing lymphocytes are called
lymphoblasts.

Abnormal cells that may be seen in the bone marrow

If your pathologist sees other types of cells not normally found in the bone marrow,
they will be described in your report. Cancers that start in another part of the body
can spread to the bone. This is called a metastasis. Additional tests may be ordered
to determine where the abnormal cells come from. Lymphomas can also involve
the bone marrow and your doctor may do a bone marrow examination as part of
your staging.

Iron stain
Iron is stored in the bone marrow. Your pathologist can use a special stain for iron
on an aspirate slide to determine if there is a normal amount of iron is present in
the bone marrow.

The iron stain also helps your pathologist see abnormal cells called ring
sideroblasts. These cells can be seen in various circumstances such as exposure to
toxins, some medications, copper deficiency, but also in some types of bone
marrow diseases such as myelodysplastic syndromes.

Fibrosis
Fibrosis is a word pathologists use to describe the look of a scar under the
microscope. Your pathologist may order special stains such as reticulin and Masson
Trichrome to look for areas of fibrosis and to determine the severity.

Certain types of diseases can cause fibrosis in your bone marrow. If there is too
much fibrosis, this can affect the function of your bone marrow. In certain types of
diseases, such as myeloproliferative neoplasms, the amount of fibrosis is related to
the severity of the disease

Bone marrow is a specialized type of tissue found at the centre of a bone.

 A bone marrow examination is often performed to look for diseases such as
lymphoma and leukemia.
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References

https://www.mypathologyreport.ca/how-to-read-your-bone-marrow-report/

https://medlineplus.gov/lab-tests/bone-marrow-tests/

https://www.mountsinai.org/health-library/tests/bone-marrow-biopsy