Bone Marrow Examination Procedures Quiz

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Questions and Answers

Which of the following is the primary purpose of a bone marrow aspiration?

To collect a solid piece of bone marrow for microscopic examination.

To identify types and proportions of hematologic cells. (correct)

To detect focal lesions such as lymphomas and granulomas.

To assess the cellularity of bone marrow tissue.

What is the key advantage of a bone marrow biopsy over a bone marrow aspiration?

It is less invasive and painful procedure to perform.

It allows for assessment of bone marrow architecture. (correct)

It allows assessment of fine cytological details.

It provides better samples for microbiological cultures.

Which of the following tools is specifically used in a trephine biopsy procedure?

Fine-gauge aspiration needle.

Surgical scalpel and forceps.

Standard hypodermic needle.

Jasshidi-swain or Islam trephine needle. (correct)

Under which condition is a surgical bone marrow biopsy typically performed?

Under aseptic procedures in an operation theater. (C) Signup and view all the answers

Which analysis is best suited for bone marrow aspiration but NOT for bone marrow biopsy?

Cytogenetic and molecular studies. (C) Signup and view all the answers

For infants under 2 years needing bone marrow aspiration, what is the preferred site?

Proximal anterior portion of the tibia (C) Signup and view all the answers

What is the primary reason to avoid aspirating more than 0.3 ml of bone marrow?

It can lead to dilution of the marrow with blood, interfering with processing and analysis. (B) Signup and view all the answers

In cases of 'dry tap' during bone marrow aspiration, what additional procedure is essential?

A needle or trephine biopsy (B) Signup and view all the answers

What is the recommended minimum fixative time for bone marrow films to achieve high quality staining with Romanowsky dyes?

20 minutes in methanol (B) Signup and view all the answers

What stain is most appropriate to demonstrate the presence or absence of iron in bone marrow?

Perl's stain (B) Signup and view all the answers

Which of the following factors influences the selection of a bone marrow aspiration site?

Patient's age (D) Signup and view all the answers

In adults, where is active bone marrow typically located for aspiration purposes?

Central skeleton (D) Signup and view all the answers

What is considered the best site for bone marrow aspiration when only aspiration is required and why?

Sternum, because it is easiest to puncture and yields the most cellular samples (C) Signup and view all the answers

Which of these is considered a disadvantage of using the sternum for bone marrow aspiration?

Increased patient distress due to visibility of procedure (B) Signup and view all the answers

Why is the posterior iliac crest an advantageous site for bone marrow aspiration?

A micro trephine biopsy can be performed immediately if no material is aspirated. (C) Signup and view all the answers

Which of the following is NOT a typical use of hematological cell marker studies?

Assessment of bone marrow cellularity (C) Signup and view all the answers

What is the primary purpose of labeling antibodies with fluorescent dyes in cell marker studies?

To allow for detection of the antibody-cell complex with a flow cytometer. (B) Signup and view all the answers

How is the expression of proteins used in cell marker studies to understand cell development?

By recognizing the presence or absence of particular proteins at different stages of maturation. (A) Signup and view all the answers

What methodology is typically associated with analyzing hematological cell markers using cluster differentiation (CD)?

Flow Cytometry (A) Signup and view all the answers

What is the primary role of specific antibodies (antisera) in flow cytometry analysis of cell markers?

To bind selectively to specific cell surface or intracellular proteins. (B) Signup and view all the answers

What do the 'CD' markers represent in hematological cell marker studies?

Specific proteins on cell surfaces (A) Signup and view all the answers

The detection of hematological cell markers is essential for which of the following?

Characterization of acute leukemia (A) Signup and view all the answers

Monoclonal or polyclonal antisera is used in combination with which other technique to identify cell markers?

Immunofluorescent Method using Flow Cytometry (C) Signup and view all the answers

What is the primary purpose of rotating the mixture at 33 rpm during the LE cell test preparation?

To facilitate the interaction between the LE factor and the cells. (C) Signup and view all the answers

Why is it necessary to search the edges and tails of the film when examining for LE cells?

LE cells are more frequently found in areas where the cells are less densely packed. (D) Signup and view all the answers

What characteristic helps in distinguishing 'tart cells' from LE cells?

Tart cells are monocytes that have phagocytosed a nucleus, while LE cells are neutrophils with characteristic inclusions. (C) Signup and view all the answers

What is the significance of a positive LE cell test in a patient?

It is highly suggestive of SLE, but not always conclusive. (D) Signup and view all the answers

What is the purpose of fixing the buffy coat smears in methanol before staining?

To dehydrate the cells, preventing their degradation and allowing optimal structural preservation. (C) Signup and view all the answers

What is the primary purpose of Fluorescence in situ hybridization (FISH) in the context of leukemia?

To identify specific chromosome translocations associated with certain leukemias. (C) Signup and view all the answers

A patient is diagnosed with Chronic Myeloid Leukemia (CML). Which chromosomal translocation is most likely to be identified using cytogenetic analysis?

t(9;22) (A) Signup and view all the answers

Which chromosomal translocation is specifically associated with acute promyelocytic leukemia?

t(15;17) (C) Signup and view all the answers

What is the underlying mechanism of Systemic Lupus Erythematosus (SLE)?

An autoimmune reaction where the immune system attacks the body's own tissues. (D) Signup and view all the answers

Which of the following is NOT a typical clinical manifestation of Systemic Lupus Erythematosus (SLE)?

Leucocytosis (B) Signup and view all the answers

What is the LE cell phenomenon primarily caused by?

A serum factor (immunoglobulin) causing depolymerization of nuclear chromatin. (B) Signup and view all the answers

Which cell type typically functions as the phagocyte involved in the LE cell phenomenon?

Neutrophil Polymorph (B) Signup and view all the answers

What characteristic feature is observed inside an LE cell?

A spherical, homogeneous mass that stains purplish brown (C) Signup and view all the answers

Why is some degree of trauma to leucocytes necessary for a successful LE cell demonstration?

To make the leucocyte nucleus more susceptible to depolymerization by LE factor. (D) Signup and view all the answers

What is the initial step in the rotary method of Zinkham and Conley for demonstrating LE cells?

Transferring 1ml of heparinized patient blood into a glass tube. (C) Signup and view all the answers

Study Notes

Bone Marrow Smear Preparation, Staining, and Examination

Bone marrow examination is a crucial diagnostic tool in hematology.
Bone marrow examination involves the analysis of bone marrow samples obtained through aspiration and biopsy.
The aspirate yields a semi-liquid bone marrow sample, suitable for light microscopy, flow cytometry, chromosome analysis, or PCR.
A trephine biopsy provides a solid bone marrow sample for microscopic examination, including immunohistochemistry, for cellularity and infiltrative processes.
Bone marrow procedures are ordered based on clinical symptoms and peripheral blood findings.
Bone marrow puncture is contraindicated in patients with severe bleeding disorders (e.g., hemophilia, vitamin K deficiency).
Common complications are mild soreness lasting 12-24 hours after the procedure.

Objectives of Bone Marrow Examination

At the end of a bone marrow examination, a pathologist can:
Discuss the clinical conditions requiring bone marrow examination.
Identify suitable bone marrow aspiration sites for various age groups.
Describe the techniques for preparing and examining bone marrow smears.
Evaluate bone marrow cellularity.
Determine the myeloid-to-erythroid ratio.
Perform a differential count on bone marrow smears.

Bone Marrow Aspiration vs. Biopsy

Both procedures are invasive and require technical skill, but aim for different outcomes.
Aspiration collects bone marrow fluid, used for identifying cell types and morphology. It's typically simple, safe, and less painful than a biopsy.
Biopsy collects a solid bone marrow sample that allows assessment of cellularity and architecture, and can detect focal lesions, granulomas, multiple myelomas and other diseases.

Bone Marrow Specimen Collection

Typically done through the posterior iliac crest and less frequently on the sternum or other sites.
Different needles (e.g., Salah, Klema, Jamshid) are used based on the nature of the procedure and the patient.
Procedures are performed under sterile conditions, often in an operating theatre.

Indications for Bone Marrow Examination

Unexplained anemia and cytopenia/pancytopenia.
Mulitlineage abnormalities of circulating blasts in adults.
Abnormal peripheral blood smear morphology.
Diagnosing, staging, and monitoring hematologic malignancies.
Investigating suspected bone marrow metastases.
Unexplained focal bony lesions or unexplained organomegaly/mass lesions.
Microbiological evaluations for fever of unknown origin or infections.
Evaluation of iron stores.
Monitoring after chemotherapy, radiation therapy, or a stem cell transplantation.

Bone Marrow Films

Preparing bone marrow films involves spreading the sample on glass slides and staining with Romanowsky dyes.
Longer fixation times (e.g., at least 20 minutes in methanol) are necessary for high-quality bone marrow staining.
Using Perl's method can help assess iron content.

Particle/Crush Smears

Particle/crush smears involve placing bone marrow particles between slides and pulling them apart.
This method provides an accurate reflection of bone marrow morphology.
Squashing and smearing can cause cellular disruption and distortion, impacting the accuracy of the study.

Systemic Scheme for Examining Aspirated BM films

Low power (x10): Assess cellularity and megakaryocytes, identify clumps of abnormal cells, and assess macrophages.
Higher power (x40-x100): Identify stages of hematopoiesis in myeloid and erythroid lineages, calculate M:E ratio, perform differential counts, observe for areas of necrosis, and evaluate iron content.

Cellularity of Bone Marrow

Cellularity is assessed relative to the patient's age and site of aspiration and compared to areas occupied by fat spaces and nucleated cells.
Normal bone marrows are noted as either normocellular or normoplastic.
Higher values than expected for a patient indicate hyperplasia, which can be seen in conditions like polycythemia.
Lower values indicate hypoplasia and are associated with marrow failure (e.g., aplastic anemia, myelofibrosis).

Myeloid-to-Erythroid Ratio (M:E)

This ratio describes the relationship between myeloid and erythroid cells in bone marrow.
In normal adult bone marrow, myeloid cells outnumber erythroid cells.
An increase or decrease in this ratio can indicate a specific disease or condition.

Differential Count on Aspirated Bone Marrow

The assessment of cell types as percentages is not routinely performed, due to the time involved and its limited clinical value.
Irregular cell distribution and inclusion of peripheral blood cells can affect the reliability of the count.
A minimum of 200 cells should be studied if performing differential counting.

Terminal Deoxynucleotidyl Transferase (TdT)

TdT is a nuclear enzyme marker for primitive lymphoid cells, used to study lymphoblastic leukemia.
High levels are common in lymphoblastic leukemias, less common in acute myelogenous leukemias (AMLs).

Molecular Methods (FISH)

Newer DNA probes and PCR techniques are utilized to rapidly confirm chromosomal abnormalities and monitor residual diseases.
FISH (fluorescence in situ hybridization) identifies specific chromosome translocations associated with particular leukemias.

Systemic Lupus Erythematosus (SLE)

SLE is a chronic rheumatic autoimmune disease.
The immune system attacks its own tissues, leading to inflammation, widespread inflammation and tissue damage.
Commonly it is seen in childbearing-age women and may include clinical features like skin rash, arthralgia, fever, renal, cardiac and vascular lesions.

LE Cell Phenomenon

LE cells are abnormal cells produced in SLE.
They are characterized by an immunoglobulin of the IgG, IgM or IgA class that causes the depolymerization and phagocytosis of the nuclear chromatin by an intact polymorph.
The distinguishing features of the LE cell in the cellular morphology include:
- Ingested nucleus or cellular materials.
- The bulk of the cell is occupied by a spherical, homogeneous mass that stains purplish brown.
- The polymorph's lobes are wrapped around the ingested material.
LE cell detection requires preparing specific types of bone marrow slides and requires expertise.

Demonstration of LE Cells

Identifying LE cells involves examining films, especially their edges and tails, for at least 10 minutes and analyzing (minimum of 500 polymorphs).
Dead nuclei in films may heighten suspicion but aren't diagnostic on their own.
Differentiating LE cells from "tart cells" (monocytes with ingested material) is essential for proper diagnosis

Method of LE Cell Detection (Rotary Method)

A method for detecting LE cells using a patient's blood sample.
The procedure involves using heparinized blood, glass beads, and a centrifugation step to prepare a smear from the blood.
The smear is then prepared for staining and examination.

"Tart Cells"

Tart cells are monocytes or histiocytes with engulfed viable nuclei.
These are not equivalent to LE cells, and don't provide any diagnostic value.
Critical for distinguishing from LE cells, which can be confused with "tart cells."

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Description

Test your knowledge on bone marrow aspiration and biopsy techniques with this comprehensive quiz. Explore the advantages, tools, and specific procedures related to bone marrow examinations. Perfect for medical students and health professionals seeking to enhance their understanding of hematology.