Pitfalls in obtaining and interpreting bone marrow aspirates: to err is human

Abstract

Pitfalls relating to bone marrow aspirates and their interpretation start even before the aspirate is obtained. There can be failure to perform an aspiration that is clinically indicated or, conversely, an aspiration may be done that is not actually necessary. Once an aspirate is obtained it may be unhelpful because it is a blood tap or very dilute, or because of the sampling error that is intrinsic to the procedure. Even if an adequate aspirate is obtained, it may be misinterpreted. Megaloblastic marrows and children's marrows with increased haematogones or marked reactive changes are particularly prone to misinterpretation. A constant awareness of potential pitfalls and an assessment of the aspirate in the appropriate clinical context will help to reduce errors.

Minimal residual disease monitoring cannot fully replace bone marrow morphology in assessing disease status in pediatric acute lymphoblastic leukemia

“…Accordingly, there may also be treatment-induced changes in MRD marker profile or undetected subclones at diagnosis and thus failure to detect or underestimation of residual disease. Furthermore, contribution of bone microenvironment, cell adhesion and cell stroma interactions may also influence sample quality (17)(18)(19). To a certain extent, this may be overcome by always combining aspiration with trephine biopsy and touch imprint preparations (17,20).…”

“…Furthermore, contribution of bone microenvironment, cell adhesion and cell stroma interactions may also influence sample quality (17)(18)(19). To a certain extent, this may be overcome by always combining aspiration with trephine biopsy and touch imprint preparations (17,20). BM touch imprints and trephine biopsies play a crucial role in the diagnostic workup of acute leukemia, particularly when there are severe pancytopenia and a dry tap or a bloody tap on BM aspiration.…”

Evaluating the evidence for evidence‐based medicine: are randomized clinical trials less flawed than other forms of peer‐reviewed medical research?

“…While it is problematic that 38.7% of published RCTs that receive detailed review are found to have methodological issues (Table 4), this finding must be kept in context. Research proceeds by trial and error (6), so to err in clinical medicine is human (35). However, as medical decision making profoundly affects patients, clinicians cannot be complacent about the validity of RCTs for guiding clinical decision making (36).…”

ICSH guidelines for the standardization of bone marrow immunohistochemistry

“…If the BM sample does not contain the lesion, no special studies could compensate for the deficiency of proper sampling . Therefore, general guidelines for BM biopsy should be followed in the first place . Recommendation 3 . It is recommended that the interpretation starts with the evaluation of the external control(s), by which it is determined that the proper antibody was applied and the test is properly calibrated. Recommendation 4 .…”