• Implicitly desired information when BM done in:
  1. a new acute leukemic case, initial diagnostic marrow:
     • correct diagnosis
     • percentage cellularity, and
     • percentage blasts
     • any indication of arising out of MDS
  2. a new acute leukemic, following induction chemo:
     • report & diagnosis to recap the leukemic type
     • report & diagnosis to state PB & BM blast percentage
     • note any presence or absence of chemo effect
     • opine as to any achievement of induction of remission [S-01-12630, acute monocytic retaining 8% mod. diff. monocytics]
     • note presence or absence of any apparent M or E stimulant effect
  3. a new chronic leukemic case, initial diagnostic marrow:
  4. a chronic leukemic case, follow-up marrow:
     • CLL:
     • CML: check previous studies and see if evidence of acceleration (increasing blast count; worsening anemia &/or thrombocytopenia)
  5. a (mono-, bi-, odd pan-)cytopenia of uncertain etiology workup: is marrow hypercellular &, if so, leukemia vs. MDS vs. MPS?
  6. a probable/possible myeloproliferative syndrome workup: is marrow hypercellular (MPS always is)? Is spleen enlarged (MPS almost always)? Is there peripheral basophilic leukocytosis (MPS almost always)?
  7. a probable/possible myelodysplastic syndrome workup: is there a PB cytopenia? Is marrow hypercellular (MDS always is)? Is spleen enlarged (MDS not so)? Is there peripheral basophilic leukocytosis (MDS not so)?
  8. a thrombocytopenia of uncertain etiology workup: Is it failure to produce enough platelets (decreased BM megs & all small PB platelets)? Or, is it increased utilization of platelets (increased BM megs & many intermediate sized PB platelets)? If ITP, see little or no budding of platelets from meg edges & should see meg hyperplasia (in marrow sections, two megs touching is hyperplasia [S-04-12680]); if due to "toxicity", look for meg vacuoles; if due to MDS, look for meg dyspoiesis. If CBC smear has easily found intermediate-sized platelets, then low count is due to increased "utilization" of platelets.
  9. an anemia of uncertain etiology workup: Iron deficiency? Chronic disease (iron uptake blockade...lots of RES iron and few to no sideroblasts)? Occult myeloma? Granulomata? Hypercellular (leukemia vs. MDS vs. MDS/MPS overlap vs. MPS vs. hemolysis vs. met. ca.)?
  10. MGUS workup: plasma cells increased (plasmacytosis of uncertain etiology vs. malignant cytology of myeloma?
  11. lymphoma staging marrow: increased lymphoid ( small foci non-paratrabecular benign vs. paratrabecular malignant)?
• Significance of some morphological findings:
  1. the M:E ratio:
     • decreased:
     • normal:
     • increased:
       1. Neupogen therapy
  2. increased presence of mast cells:
     • cytokine therapy, especially Interleukin-3 [S-01-4205]
  3. increased presence of megakaryocytes: (when megs touch each other, there are too many)
     • reactive
     • "neoplastic"
       1. reticulin fibers encircle individual megakaryocytes (as in MPS [LMC-01-2306])
       2. abnormal platelet aggregation studies
       3. abnormal cytogenetic studies
  4. abnormal trabeculae: keep eyes open for clinically occult histo-morphologic evidence of osteoporosis, Paget's disease, and metabolic disease causing excessive osteoblasts and/or osteoclasts and evidence of trabecular remodeling and/or foci of woven rather than lamellar bone [S-05-9777].

(posted 2002; latest addition 17 August 2005)