Bone Marrow Examination A bone marrow aspirate and smear or a needle biopsy may be useful in the evaluation of some patients with anemia. In patients with hypoproliferative anemia and normal iron status, a bone marrow is indicated. Marrow examination can diagnose primary marrow disorders such as myelofibrosis, a red cell maturation defect, or an infiltrative disease (Figs. 58-14, 58-15, and 58-16). The increase or decrease of one cell lineage (myeloid vs. erythroid) compared to another is obtained by a differential count of nucleated cells in a bone marrow smear [the myeloid/erythroid (M/E) ratio]. . | Chapter 058. Anemia and Polycythemia Part 8 Bone Marrow Examination A bone marrow aspirate and smear or a needle biopsy may be useful in the evaluation of some patients with anemia. In patients with hypoproliferative anemia and normal iron status a bone marrow is indicated. Marrow examination can diagnose primary marrow disorders such as myelofibrosis a red cell maturation defect or an infiltrative disease Figs. 58-14 58-15 and 58-16 . The increase or decrease of one cell lineage myeloid vs. erythroid compared to another is obtained by a differential count of nucleated cells in a bone marrow smear the myeloid erythroid M E ratio . A patient with a hypoproliferative anemia see below and a reticulocyte production index 2 will demonstrate an M E ratio of 2 or 3 1. In contrast patients with hemolytic disease and a production index 3 will have an M E ratio of at least 1 1. Maturation disorders are identified from the discrepancy between the M E ratio and the reticulocyte production index see below . Either the marrow smear or biopsy can be stained for the presence of iron stores or iron in developing red cells. The storage iron is in the form of ferritin or hemosiderin . On carefully prepared bone marrow smears small ferritin granules can normally be seen under oil immersion in 20-40 of developing erythroblasts. Such cells are called sideroblasts. Figure 58-14 Sourto Fiud AS. KtiptrOL Smjnu ld t. SL Longo OL. Jamaion JL. Loaoalco frwnpXaj of oto. oa 17th Edition i httpi vwv. acca Copyright C Th Mc 5r -Hll iwipiniti inc. Al rLghtf41 i TCl. Normal bone marrow. This is a low-power view of a section of a normal bone marrow biopsy stained with hematoxylin and eosin H E . Note that the nucleated cellular elements account for 40-50 and the fat clear areas accounts for 50-60 of the area. From Hillman et al. Figure 58-15 5SUCW Fiuci AS Kaspar DL. Braunwald F Hau car SL. Longo t L Jim on JL. Locate Ji Prinapfts vf Internet 17th Edition http .
