The page below is a sample from the LabCE course Bone Marrow Aspiration: Normal Hematopoiesis and Basic Interpretive Procedures. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Stromal Cells

Stromal cells are the cells that comprise the backbone of a bone marrow fragment. They provide the support matrix as well as some of the nutrients necessary for the growth of all cellular precursors found in the bone marrow.

Stromal cells appear similar to macrophages and tend to be found in sheets. Usually, they are deep in the heart of a fragment. When the differential is counted in the areas adjacent to the fragments, they may not be noticed and should not be counted. While stromal cells may be present in clusters, it is important to recognize that these cells are normal bone marrow elements and are not tumor cells.

In aplastic bone marrows, or bone marrows with decreased cellularity, they may be more apparent. However, since they are considered tissue cells, they are not included in the differential.

The top image to the right demonstrates a typical stromal clump. The bottom image shows stromal cells mixed with phagocytic macrophages.