Bone Marrow Case Study

Historical aspects of bone marrow study- A concise history
The oldest known procedure carried out on mankind is that of trepanning. Skulls 8000–10,000 years old showing evidence of medical intervention have been found in Europe, Northern Africa, Asia and New Zealand (Fig 1). This extensive distribution has been attributed to Asiatic origins. Many of these ‘patients’ survived as shown by evidence of healing of their bones (Fig 1). In Peru, from where a large amount of information comes, the procedure is likely to have been carried out to relieve headaches, mental illness and to relieve intracranial pressure. Peruvians used sharp knives of obidian, stone and bronze for trephination, as well as bone instruments, bandages, native cotton and other

Aplastic anaemia has been categorized, on the basis of peripheral blood and bone marrow features as severe, very severe or non-severe. Aplastic anaemia is classifi ed as severe if at least two of three peripheral blood criteria are met – reticulocyte count less than 1% or less than 60x109/L, neutrophil count less than 0.5x109/L and platelet count less than 20x109/L; in addition, bone marrow cellularity must be less than 25%. Patients with very severe aplastic anaemia have a granulocyte count less than 0.2x 109/L. Other cases are categorized as non- severe. Bone marrow may be difficult to aspirate with the result being a ‘dry tap’ or ‘blood tap’, but more often aspiration of fragments is possible. In the majority of patients a hypocellular aspirate is obtained with the fragments being composed largely of fat. The cell trails are also hypocellular. Different lineages are affected to a variable extent so that the

Dyserythropoiesis may be seen and is often marked. Dysplastic changes in granulocytes are less common. There is no disproportionate increase in immature granulocyte precursors. Megakaryocytes are often so infrequent in the aspirate that it is difficult to assess their morphology but dysplasia is not a feature. In a minority of patients the aspirate is normocellular or even hypercellular. Examination of trephine biopsy specimens from such patients shows that such ‘hot spots’ coexist with extensive areas of hypoplastic marrow. The bone marrow aspirate shows at least a relative increase in lymphocytes and sometimes an absolute increase. There may also be increased numbers of plasma cells, macrophages and mast cells. Foamy macrophages are sometimes present and macrophage iron is increased. Trephine biopsy is crucial in the diagnosis of aplastic anaemia. The bone marrow is usually hypocellular with a marked reduction of haemopoietic cells. Myeloid cells are mainly replaced by fat but there is a variable inflammatory infiltrate composed of lymphocytes, plasma cells, macrophages, mast cells and sometimes eosinophils.

Diagnosis of