[Histonet] Re: bone marrow assisting?

[Robert Richmond]

Anna Inman at St. Mary's Hospital, Grand Junction CO asks:

>>I am looking for some info on technique at bone marrow procedures. - Are aspirates being dropped from the syringe onto the slides or onto a petri dish and only marrow with spicules transferred to slides or something else? ?? - Is the syringe heparinized??<<

If you don't know how to do this, it's your pathologist's job to teach
you how. Grump.

We're talking about a posterior iliac crest biopsy, with a core of
bone and a syringe full of marrow particles (not spicules) and blood.

There are a lot of ways to do this. A very simple method: set a glass
slide at about a 15 degree slant. Squirt some of the specimen out of
the syringe onto the high end of the slide. The blood will run down
the slide, leaving the marrow particles loosely adhering to the slide.
Pick up particles one at a time, using a wooden applicator stick
broken with the grain to form a tiny flat scoop. Spread and smear each
particle between two slides or square coverslips, for as many slides
as you want.

Heparin isn't needed, and may damage the specimen. If you use it, use
only a very small quantity.

The remaining specimen may be allowed to clot in the syringe, removed,
and fixed for clot sections. I prefer to squirt the remainder of the
specimen, not yet clotted, into neutral buffered formalin, and later
filter the fixed particles out and embed them in a paraffin block. Why
look at (or cut?) all that clot?

The person performing the marrow biopsy should not be the same person
who does the preparation - it's a two person job.

If you don't see any particles on the slide, inform the person doing
the aspiration so they can repeat the aspiration. (Some biopsy-ers
never quite get the hang of this.) Don't B.S. me - if I haven't got
any marrow particles, I want to know!

While tracking down "stmarygj" I found that the hospital has an
institute inspired by Geno Saccomanno, the inventor of the well-known
cytology fixative.
http://www.stmarygj.com/body.cfm?id=61

Bob Richmond
Samurai Pathologist
Knoxville TN