Overview
Bone marrow is the primary postnatal factory for blood cell production, housed within medullary spaces and supported by vascular and stromal niches.
Classification
| Procedure | Material obtained | Typical laboratory use |
|---|---|---|
| Aspiration | Liquid marrow with cells | Smear morphology, flow, cytogenetics per order |
| Biopsy (core) | Intact trephine core | Cellularity, fibrosis, infiltration |
| Touch imprint | Cells from biopsy core | Cytology correlation |
Morphologic Features
Marrow smears show lineage precursors at various maturation stages. Detailed dysplasia and blast criteria are advanced topics, peripheral smear remains the first screening surface for circulating immature cells.
Laboratory Characteristics
- Simultaneous peripheral smear/CBC often required for correlation
- Adequate biopsy length and processing fixatives per institutional histology SOP
- Ancillary studies ordered on dedicated samples, not assumed reflex
Reference Intervals
Cellularity reference descriptions are age-dependent and reported qualitatively or semi-quantitatively by pathology, verify local reporting standards.
Clinical and Laboratory Significance
- Unexplained cytopenias
- Suspected infiltration or storage disease
- Staging and monitoring known hematologic neoplasm
- Fever with abnormal counts when indicated clinically
Differential Considerations
Peripheral pancytopenia may reflect production failure, sequestration, or destruction, marrow distinguishes hypoplasia from ineffective hematopoiesis or infiltration when clinically indicated.
Comparison Tables
Peripheral vs marrow
| Question | Peripheral blood | Marrow study |
|---|---|---|
| Are blasts present? | May detect circulating blasts | Quantifies marrow blast burden |
| Is production adequate? | Infer from counts/retics | Direct precursor and cellularity assessment |
| Is there fibrosis? | Not visible | Biopsy with special stains |
Classification Frameworks
WHO haematolymphoid tumour classification integrates marrow morphology, immunophenotype, and genetics, introduced in advanced modules; this entry covers introductory sampling correlation only.
Laboratory Notes
- Time-stamp simultaneous peripheral and marrow specimens when correlation is requested
- Aspiration and biopsy are complementary, institutional protocols define when both are required
References
Authoritative textbooks, guidelines, and reviews supporting this reference entry. Verify reference intervals, critical limits, and reflex criteria against institutional protocols and current guideline editions.
Textbooks
- McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Elsevier; 2021.
- Rodak BF, Carr JH. Rodak's Hematology: Clinical Principles and Applications. 6th ed. Elsevier; 2020.
- Hoffbrand AV, Moss PAH, Pettit JE. Essential Haematology. 8th ed. Wiley-Blackwell; 2019.
- McKenzie SB, Williams JL. Clinical Laboratory Hematology. 4th ed. Pearson; 2022.
Professional Monographs
- Barnes PW, McFadden SL, Machin SJ, Doig K. Laboratory Hematology Practice. Wiley-Blackwell; 2012.
CLSI and Professional Guidelines
- Clinical and Laboratory Standards Institute. Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Standard. CLSI document EP28-A3c. CLSI; 2010.
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