The science of the causes and effects of diseases.
The basic principle in pathology is pattern recognition. Variations in each and every disease process make the basic principle part challenging. There is an exception to each and every rule. Good judgment is extremely helpful.
Good judgment comes from experience, which mostly comes from bad judgment. Will Rodgers
“It ain’t what you don’t know that gets you in trouble; it’s what you know for sure that just ain’t so”. Mark Twain
Unexplained anemia, abnormal red cell indices, cytopenias or cytoses. Abnormal peripheral blood smear morphology suggestive of bone marrow pathology. Diagnosis, staging and follow-up of acute and chronic leukemias, myelodysplastic syndromes, chronic myeloproliferative disorders, lymphomas, plasma cell myeloma, amyloidosis, and mastocytosis.
Suspected bone marrow metastases. Focal bony lesions on radiological imaging. Unexplained organomegaly or presence of mass lesions inaccessible for biopsy. Fever of unknown origin. Evaluation of iron stores. Lipid/glycogen storage disorders.
Core should be at least 1 cm in length. Approximately 7 ml of aspirate is required to perform morphology, flow cytometry, fluorescence in situ hybridization (FISH), and cytogenetics. EDTA tube is required for smears (do not use sodium heparin because of staining artifact). Flow cytometry, FISH, and cytogenetics use sodium heparin tubes.
Best to perform aspirate with Illinois needle. Draw approximately 15 cm of vacuum. Portion of aspirate can be squirted directly into formalin.
Generally occurs in “packed” marrows, fibrotic marrows, or marrows with metastatic disease. “Packed” marrows are generally acute or chronic leukemias with 100% cellularity. Fibrotic marrows are generally myeloproliferative disorders, damaged marrows with fibrosis, or “Hairy cell” leukemia.
Redirect Jamshidi before collecting bone core.
When possible try to attain a consolidated report format (contains morphology, flow and FISH, and cytogenetics results). Each testing type is less specific as a stand alone test, but combined become very powerful diagnostically.