Indications of Bone Marrow Biopsy

What are the indications of Bone Marrow Biopsy?

The International Council for Standardization in Hematology has published guidelines for bone marrow biopsy to promote consistency in performance and reporting. Although bone marrow biopsy techniques is safe, it should be performed with a clear idea as to how the results will help distinguish the differential diagnoses under consideration or provide follow-up of treatment.

When Bone Marrow Biopsy is really needed!

In many hematologic disorders, such as most cases of iron deficiency anemia, thalassemia, and acquired and inherited hemolytic anemia, examination of the blood and specialized laboratory tests may suffice to make the diagnosis without the need for a bone marrow biopsy examination. When examination of the bone marrow is indicated, the decision as to whether an aspirate only or an aspirate plus biopsy is desired should be made. Aspiration is always attempted because of the superior morphology offered by examination of the aspirate smear. However, a bone marrow biopsy is superior to the aspirate in quantifying marrow cellularity and diagnosing infiltrative diseases of the marrow and should be performed when these conditions are part of the differential diagnosis. In low-grade lymphoma, the marrow frequently is involved at the time of diagnosis, and this involvement is most sensitively detected by bone marrow biopsy.

Interpretation of Bone Marrow Biopsy

Bone Marrow biopsy is useful for diagnosing and following the course of disorders that are commonly associated with reticulin fibrosis, such as megakaryoblastic leukemia, hairy cell leukemia, and the chronic myeloproliferative disorders. In myelodysplastic syndromes, bone marrow biopsy is useful for evaluating abnormal localization of immature precursor cells and abnormal megakaryocytes.

Depending on the diagnostic question, availability of material, and expected frequency of the abnormal cells, an appropriate selection of specialized diagnostic methods may be needed to support the clinical diagnosis. Morphology of marrow cells is still the gold standard for diagnosis of hematologic malignancy and allows construction of a good differential diagnosis for nonmalignant disorders. Immunocytochemistry provides excellent phenotype–morphology correlation on an individual cell basis, but is limited to epitopes that resist fixation and/or drying.