Hey everyone! Felicia here once again. :)
I'm now attached to the Bone Marrow Morphology Lab for 3 weeks. This lab has the most senior medical technologists and is considered one of the most exciting and challenging labs amongst all the others labs in Haematology. When situated in this lab, one will have the golden opportunity to go down to the wards and experience how the bone marrow is being aspirated out from patients! Indeed it may give one a nauseating feeling, but this is what makes the job in this lab so exciting about. ;)
Bone Marrow Preparation, Staining & ReportingAfter clinical history, physical examination and the review of peripheral blood film, bone marrow examination is the next most important step used in the diagnosis of haematological disorders. It is the only way used in the classification of leukaemias and myelodysplasias. It allows the assessment of the body iron stores, marrow cellularity, myeloid to erythroid ratio, maturation of cell lines and relative quantitation of eosinophils, lymphocytes and plasma cells. In addition, infiltration by fibrosis and other malignant cells can also be diagnosed. It is also used to assess response to treatment in leukaemias and to assess prognosis in aplastic anaemia and agranulocytosis. The absence of iron stores help to differentiate iron deficiency anaemia from other hypochromic anaemias. Trephine (a fixative for the bone) biopsy may help to diagnose myelofibrosis, aplasitc anaemia, malignant lymphoma or secondary carcinoma.
Equipments & Materials1. Microscope
2. Multitimer
3. Differential counter
4. Glass slides
5. Spreader
6. May-Grunwald stain
7. Giemsa stain
8. Buffered distilled water pH8.6
9. Mounting medium DPX
10. Adhesive labels
11. Reporting worksheets
Specimen CollectionThe marrow aspirate can be obtained from the posterior superior iliac spine due to its accessibility and relative safety which a sample can be obtained.
Preparation of bone marrow smearsBone marrow smears can be made directly at the beside during aspiration procedure. The sample is then sent to the lab for slide preparation.
Wedge smearsAbout 0.3ml of bone marrow from the first stringe is put onto a clean glass slide to allow the blood to drain away onto another slide. The marrow fragments tend to adhere to the slide and most of them will be left behind. A smooth edge spreader of not more than 2cm in width is used to make 10-12 wedge smears of size 2x3cm. The marrow fragments are then dragged behind the spreader and they leave a trail of cells behind them. Differential counts are then performed by the senior staff.
Squashed preparationA few particles are placed on the centre of a clean glass slide in which another slide is gently compressed to spread and disperse the particles as the slides are pulled apart.
Trephine imprintSeveral touch or imprint of the bone fragment are prepared by gently touching the core and rolling between 2 slides.
Handling conditions1. All bone marrow smears are labeled with the patients' initials immediately after preparation. They are kept in separate trays and brought back to the lab with request forms to be filled in by staff.
2. A unique marrow number is assigned to each patient sample and are written in request forms, record book etc.
3. 2 wedge smears, 1 blood film, 1 squashed preparation and an imprint are selected for May Grunwald Giemsa staining. Another wedge smear with visible particles is used for iron staining. Controls with normal/increased iron stores are stained in parallel with the patients' smear.
Bone Marrow Smear - May Giemsa Stain (x1000)
Image from: pathy.med.nagoya-u.ac.jp/atlas/doc/node76.html
4. A set of buff cards and adhesive labels for storing the smears together with a worksheet with patient's details are prepared.
5. Any unstained smears are kept in closed containers for 2 weeks for further tests, if necessary.
I've only spent 2 days in this lab, so this is whatever I've observed and learnt so far! If you guys have any queries, please do not hesitate to ask. ;)
Signing off,
Felicia
0703345I