Bone marrow aspiration and gross appearance of trephine biopsy in routine practice: a preliminary descriptive data on 176 consecutive cases from a single tertiary care center in South India

The 2008 ICSH guideline was proposed to bring uniformity in bone marrow reporting among pathologists worldwide. The objective was to study the usefulness of on-site procedural information in routine marrow reporting. The nature of marrow aspirate, gross appearance, and core length of iliac crest trephine biopsies from 174 consecutive subjects (109 males, 65 females, mean age 47.5 ± 19.2 years) were reviewed by a pathologist blinded to the final diagnosis. The nature of aspirate had a significant correlation with a positive diagnostic yield among 149/176 (84.6%) cases (P = 0.03). Among cytopenic subjects, megaloblastic anemias (MA) (N = 27) and aplastic anemias (AA) (N = 14) had richly particulate and greasy/fat rich aspirates, respectively (P < 0.001). Eighty-six of 104 (82.7%) normal vs. 61/70 (87.1%) abnormal cores (for age) yielded a diagnosis (P = 0.43). Seventeen (63%) of the MA had a deep red trephine core (P = 0.18); and 12/14 (84.5%) of the AA had yellowish trephine core (P = 0.008). Though acute leukemias (N = 38) yielded variable aspirate materials (P = 0.34), they were more likely to have a pale, discolored trephine core (30/38 (79%) vs. 8/38 (21%), P < 0.001). A core length of ≥ 15 mm (N = 155) had higher diagnostic yield compared to < 15 mm (N = 19) (P = 0.05). Careful documentation of on-site marrow procedure information is necessary; and this may provide valuable clues for the morphological diagnosis.