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The page below is a sample from the LabCE course Technical Preparation of Bone Marrow Specimens for Histological Assessment. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Bone marrow double stain (CD3 and CD79a), courtesy of Jim Burchette, Duke Immunopathology.

Bone Marrow Examination: Clinical Indications

Peripheral blood smears are often used in conjunction with laboratory and clinical data to evaluate blood abnormalities, such as anemia. When a definitive diagnosis cannot be determined from a peripheral blood smear sample, clinicians may make the decision to perform a bone marrow examination (BME).
Although clinical indications for unilateral BME can be determined on a case-by-case basis, there are some common clinical indications used to triage the medical necessity of the procedure. The unilateral BME is most often used to evaluate pervasive (wide spread) disease, such as:
  • Anemia
  • Leukemia (acute and chronic)
  • Storage disease
  • Myelodysplastic disorders, myeloproliferative neoplasms
  • Fevers of unknown origin (infectious disease)
  • Thrombocytopenia
  • Pancytopenia
  • Neutropenia
  • Immunodeficiency
Additionally, there are some common clinical indications used to triage the medical necessity of a bilateral BME. The bilateral BME is most often used to evaluate more patchy disease processes, such as:
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma
  • Plasma cell myelomas
  • Metastatic tumors