The Fellow on Call: The Heme/Onc Podcast Episode 007: Heme Path Capstone Pt. 2
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Feb 23, 2022 A case of a 50-year-old man with leukocytosis, fevers, and bruising becomes a deep dive into suspected acute myeloid leukemia. The discussion explores marrow biopsies, blast counts, dry taps, genetic testing, risk classification, and how new molecular results can shift treatment plans toward transplant.
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Always Get Aspirate And Core For Bone Marrow Biopsy
- Do obtain both an aspirate and a core during bone marrow biopsy to capture cellular detail and architecture.
- Aspirate gives cell morphology and flow cytometry; core shows marrow cellularity, fibrosis, and spatial distribution of blasts.
Spicules Confirm True Marrow Aspirate
- Insight: Spicules confirm a true marrow aspirate and prevent miscounting peripheral blood as marrow.
- Technicians look for fatty spicules immediately; hemodilute aspirates can falsely lower marrow blast percentage.
Rely On Aspirate Smear And CD34 For Blast Count
- Use aspirate smear counts plus CD34 IHC on marrow as primary blast quantification methods.
- Reserve flow cytometry as third-line since aspirates can be hemodilute and flow gating can be subjective.