Bone marrow pathology Educational course, Belgian Society of Hematology 18 Nov 2017 Dr. J. Somja, CHU Sart Tilman, Liège,
[email protected] Learning objectives When ? Bone Why ? marrow What ? examination How ? I. When ? Indications for BM examination Indications for BM examination • Haematological abnormalities that cannot be explained by available clinical and laboratory data. • A good indication is essential for an accurate diagnosis • 3 main indications : – Diagnostic purposes – Staging for malignant diseases – Monitoring Riley et al., JCLA, 2004 II. What? What specimens to collect ? (Bone marrow Particle clot) BONE MARROW Bone marrow aspirate Bacteriology Bone marrow trephine biopsy if necessary Smear Preparation + Heparin +EDTA Heparin FFPE 2-10 days Molecular Morpho, IHC, Flow biology Cytogenetics FISH, (clonal cytometr (clonal days-weeks expansion, NGS) y expansion, Karyotyping (hours) NGS, …) BM biopsy MGG Cyto- FISH Days-Weeks FISH cytology chemistr If necessary touch imprint (hours) y (hours) (days) (hours) Usefull if dry tap BM aspirate or trephine biopsy ? BM ASPIRATE BM BIOPSY • Quick results • Complete assessement of • Fine cytological detail cellularity and architecture • Enumeration of marrow • More sensitive for focal cellular elements lesions • Wider cytochemical stains • Allows grading of fibrosis can be used • Use of IHC • Ideal for flow cytometry, • Useful for assessment of cytogenetics/molecular AA, metastasis, some studies infections BM aspirate or trephine biopsy ? A thorough bone marrow examination includes both BM aspiration and trephine biopsy. – MDS: BM aspirate >>> BM biopsy – MPN: BM aspirate = BM biopsy – MPN/MDS BM aspirate > BM biopsy – AML: BM aspirate >>> BM biopsy – NHL: BM aspirate << BM biopsy – HL: BM aspirate <<< BM biopsy – MM: BM aspirate < BM biopsy – Carcinoma: BM aspirate << BM biopsy III.