Bone marrow examination

Bone marrow aspirate samples are most commonly obtained from the posterior iliac crest, although alternatively can be obtained from the sternum, anterior iliac crests and the anterior tibia (in children). Sample collection is completed after the procedure has been explained in detail to the patient and informed consent gained. Sample collection requires local anaesthesia and has many considerations for the Clinical Team; this is described in Bone Marrow Aspirate and Trephine Biopsy Policy (on intranet), which is performed in a suitable clinical environment. This invasive procedure typically produces a trephine for investigation by histology, bone marrow smears and aspirate samples stored in EDTA and heparin anticoagulated containers for Haematological for Cytogenetic and Molecular analysis, if clinically appropriate. The quality of retrieved samples has paramount importance as it directly affects the validity of the report.

The comprehensive evaluation of the bone marrow is achieved when aspirate morphology is assessed in conjunction with cell surface, molecular, cytogenetic studies along with the trephine, taking into consideration appropriate clinical details. Reporting is completed as a joint report through HiLIS.

Department of Haematology

Notes

• Performed at GRH site.
• See also: Iron Stain and Bone Marrow Biopsy Patient Leaflet.
• Also, linked to the clinical policy: Bone Marrow Aspirate and Trephine Biopsy Policy.
• Due to the invasive nature of the investigation, should only be performed by a member of the Haematology Team (or delegated alternate) and when there is clear indication. This MUST be approved by a Clinical Haematologist.
• Testing is completed with the frequency required by the Clinical Haematologist.
• Usually taken with trephine samples, performed at CGH and Molecular and Cytogenetic analysis, performed at Southmead Hospital, North Bristol Trust.

Sample requirements

At least 4ml EDTA sample, usually prepared as at least 3 bone marrow slides.

Labelled patient’s surname and forename plus unique patient identifier and date of sample and sent with a completed BHODS form or follow the link to SouthmeadHospital for the BHODS form.

Turnaround Time

7 days

Clinically urgent samples are processed as per clinical need

Interfering substances

A major source of variation surrounds the samples procedure and natural variation of human samples.

Add ons

Blood smears are usually made at the time of sampling, with some spare slides provided too. Additional slides would not usually be required, but would be made within 24 hours (but as soon as possible), if required, as requested by the Clinical Haematologist.