Diagnostic Assessment of Bone Marrow Aspiration Smears, Touch Imprints and Trephine Biopsy in Haematological Disorders

Introduction Marrow biopsy by surgical trephine is an older procedure than needle aspiration. It is only since the late 1950s that core needle biopsy of the bone marrow has been widely used. Since that time, it has had a considerable effect on diagnostic haematology, pathology and oncology. Wide acceptance is associated with the introduction of a simple procedure using the Jamshidi needle to improve the procedure, as well as the quality and size of specimens. The uses and advantages of needle biopsies are numerous. Metastatic deposits, degree of cellularity, fibrosis and assessment of dry taps can readily be determined (1,2).The present study is conducted to evaluate the role of bone marrow aspiration, touch imprints and trephine biopsy in order to optimize diagnostic utility of bone marrow examination which would be of immense value in better patient management Material and Method This study has been conducted at the Post Graduate Department of Pathology, Acharya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu (J&K). All the patients referred to the Department of Pathology, Acharya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu for diagnosis requiring bone marrow examination in haematological disorders were considered for participation in the study. After detailed haematological investigations, the commonly encountered anaemias i.e iron deficiency anaemia, megaloblastic anaemia and haemolytic anaemia were not included.Only those disorders where trephine biopsy is of utility along with bone marrow aspiration were considered eligible for the study. The standard technique was employed in obtaining the samples from posterior iliac crest using a Jamshidi needle. For preparing the aspirate particle smears, about 0.25 to 0.5 ml of aspirate was obtained into a syringe and delivered onto clean glass slides and smears prepared. The biopsy imprints were made by gently touching the core on slides. The cores were then fixed in Zenkers formalin, decalcified, embedded in paraffin and 2 um thin sections made. The particle smears and biopsy touch preparations were stained by the Wright-Giemsa and the biopsy sections were stained by the Wright-Giemsa and haematoxylin Abstract Diagnostic Assessment of bone marrow aspirate particle smears, imprints and biopsy sections was done on 40 haematological disorders. Core needle biopsy of the bone marrow is a safe and useful procedure. It is a valuable diagnostic aid for measurement of marrow cellularity and fibrosis.Bilateral trephine biopsy was conducted wherever necessary.Bone marrow aspiration was the most effective method for studying morphological details and was able to diagnose most of the cases except the 2 cases of myelofibrosis which yielded dry tap for which trephine biopsy was diagnostic.Trephine biopsy was also found to be superior for staging of lymphomas and to study the ALIP in MDS.Touch imprints were useful for studying cell morphology, where aspiration yielded dry tap.All the three procedures of bone marrow aspiration, trephine biopsy and touch imprints were found to be complementary to each other and superiority of one method over the other depended on the specific disease process.