Page 45 - Essential Haematology

Chapter 2 Erythropoiesis and anaemia / 31

Table 2.6 Comparison of bone marrow aspiration and trephine biopsy.

Aspiration Trephine
Site Posterior iliac crest or sternum (tibia in Posterior iliac crest
infants)
Stains Romanowsky; Perls ’ reaction (for iron) Haematoxylin and eosin; reticulin
(silver stain)
Result available 1 – 2 hours 1 – 7 days (according to
decalcifi cation method)
Main indications Investigation of anaemia, pancytopenia, Indications for additional trephine:
suspected leukaemia or myeloma, suspicion of leukaemia,
neutropenia, thrombocytopenia, etc. myeloproliferative disorders,
myelodysplasia, aplastic anaemia,
malignant lymphoma, myeloma
amyloid, secondary carcinoma,
cases of splenomegaly or pyrexia
of undetermined cause. Any case
where aspiration gives a ‘ dry ’ tap
Special tests Cytogenetics, FISH (see p. 160 ), Immunohistological staining

microbiological culture, biochemical
analysis, fl ow cytometry, cytochemical
markers, DNA or RNA analysis for gene

abnormalities, microarrays (see p. 160 ),
progenitor cell culture

Marrow Peripheral blood
4 120
Days
Normal

Erythroid hypoplasia,
e.g. aplastic anaemia

Erythroid
hyperplasia,
e.g. haemolytic
anaemia

Ineffective
erythropoiesis,
e.g. megaloblastic
anaemia

Figure 2.19 The relative proportions of marrow erythroblastic activity, circulating red cell mass and red cell

lifespan in normal subjects and in three types of anaemia.