Bone Marrow Aspirate and Biopsy

CERNER / EPIC MNEMONIC: BMA; BMBX;
TEST INFORMATION: Test includes H&E stain, Wright's stain, and iron stain
DAYS PERFORMED: Mon-Fri, 0800-1530; for emergencies also available stat Mon-Fri, 1530-0900 and 24 hours on weekends by contacting Hematology fellow 'on call.' Stat requests must be accompanied by a stat Hematology consult except for extenuating circumstances negotiated with the Diagnostic Bone Marrow Laboratory on an individual basis, technologists will not be available to perform or assist with bone marrows in the O.R. When applicable, arrangements for such must be made 24 hours in advance.
TURNAROUND TIME: 2-3 working days
SPECIAL INSTRUCTIONS: For adult patients schedule procedure with the Diagnostic Bone Marrow Clinic, 563-2348. Aspirates on pediatric patients are performed by pediatric hematology/oncology, 942-8114.The test must be ordered in the patient chart. Include requests for cultures, flow cytometry, cytogenetics, molecular studies, or other procedures indicated. Clinical history must be stated. Patient must have current CBC, platelet, PT and PTT results available. Patients with platelet counts <20,000/mm3 or abnormal PT and PTT results must be cleared with a Hematology attending physician. If premedication of patient is desired, the laboratory should be notified at the time the test is scheduled.
CONTAINER TYPE: Slides prepared by laboratory technologist, biopsy placed in fixative by technologist
COLLECTION: Test performed by Hematology fellow or resident physician.
SPECIMEN REQUIREMENTS: Bone marrow aspirate and/or biopsy
REJECTION CRITERIA: Order not written on patient's chart; CBC, platelet, PT, or PTT results not available or are abnormal beyond proscribed limits.
MINIMUM VOLUME: >1 cm core of bone marrow from biopsy; 2-5 mL aspirate
REFERENCE RANGE: Preliminary and final results interpreted by Hematopathologist. Phone Surgical Pathology, 942-5260 for results.
LIMITATIONS OF TEST: Aspirates containing insufficient numbers of cells may not be representative of the marrow.
ADDITIONAL INFORMATION: Written consent for a bone marrow aspirate is not required. The attending physician will explain the procedure to the patient and obtain verbal consent prior to scheduling the test with the laboratory.

Patient should lie on site for 20-30 minutes and keep site dry for 24 hours.

Evaluate bone marrow cellularity, morphology, and iron stores; may assist in diagnosis of elevated blood cell counts, cytopenias, leukemias, dysplasia, staging of lymphomas and diagnosis of certain infections (MAI, histoplasmosis, etc); marrow culture occasionally may assist in diagnosis of infection. For staging of lymphomas, for diagnosis of infections, and for evaluation of metastases, biopsy has higher yield than aspirate alone. In general, in an otherwise healthy patient, ferritin level measurement in conjunction with the serum iron, TIBC, and peripheral smear evaluation can replace bone marrow exam when the only indication for marrow exam is evaluation of iron stores.

Patient's platelet count must be > 20,000/mm3 and INR <1.5 except upon approval by a Hematology attending physician.

TEST SYNONYM(S):Bone Marrow; Bone Marrow Biopsy