Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (753 page)

   Bone marrow aspirates are used for their excellent cellular morphologic maturation and definition of cellular abnormalities, cytochemistry, cytogenetic studies, molecular studies, flow cytometry, microbial culture and identification, occasionally electron microscopic studies, and tissue culture. Aspirates can also be used for bone marrow transplantation, where large amounts of marrow need to be collected. (Concentrated peripheral blood stem cells are now used in most cases for this purpose.)

   Bone marrow biopsies are useful for examination of intact marrow tissue and overall cellularity, histochemistry, and immunohistochemistry, as well as for certain molecular diagnostic tests. Biopsies are excellent for evaluating iron stores, fibrosis, granulomas, abscesses, metastases, and vascular lesions.

   Bone marrow is studied to diagnose or follow-up various conditions that may affect it or infiltrate it.

   For the diagnosis of anemia of iron deficiency bone marrow iron stains are the gold standard; also helpful in some cases of iron overload

   Neoplasms that originate in or infiltrate the marrow: leukemias, myeloproliferative neoplasms, myelodysplastic syndromes, plasmacytic neoplasms, metastases; amyloidosis

   Staging of Hodgkin and other lymphomas

   Tumors and infections (e.g., TB) that invade the marrow and result in leukoerythroblastic peripheral blood picture (myelophthisic anemia)

   Aplastic anemia, agranulocytosis, cytopenias

   Unexplained anemia, splenomegaly, lymphadenopathy

   Megaloblastic anemias (rarely necessary)

   Exposure to drugs resulting in bone marrow damage

   Follow-up therapy for leukemias, lymphoma (in cases that present with bone marrow infiltration), myelodysplastic and myeloproliferative neoplasms

   Monitoring recovery following stem cell transplantation and marrow-ablative therapy