Afkhami Michelle, Vergara-Lluri Maria, Brynes Russell K, Siddiqi Imran N
Hematopathology Service, Department of Pathology, USC Keck School of Medicine, Los Angeles, CA, USA.
Methods Mol Biol. 2014;1180:257-69. doi: 10.1007/978-1-4939-1050-2_14.
Maximum diagnostic information is obtained when peripheral blood smears, bone marrow aspiration smears, trephine biopsy imprints, trephine and clot biopsy sections are simultaneously examined. Peripheral blood smears reflect end organ function and provide clues to underlying hematolymphoid pathology that may prompt additional studies including bone marrow examination. Bone marrow aspiration alone has diagnostic utility in the evaluation of a limited number of primary hematological conditions including: megaloblastic anemias, hyporegenerative anemias, certain hemolytic anemias, normochromic normocytic anemias, neutropenias, thrombocytopenias, immunoglobulin disorders, storage diseases, and leukemias (Bain, J Clin Pathol 54:657-663, 2001). Bone marrow trephine biopsy is indicated in those situations where marrow aspiration is unsuccessful; in evaluation of cytopenias, myelofibrosis, suspicion of lymphoma, metastatic tumor, granulomatous disease, evaluation of myeloproliferative neoplasms, and for the examination of trabecular bone in metabolic diseases (Bain, J Clin Pathol 54:737-742, 2001). Many of the indications for marrow aspiration overlap with those for trephine biopsy. Because it is not possible to predict which patients will have diagnostic aspiration biopsies and which will have diagnostic trephine biopsies, both procedures are routinely performed together (Brynes et al., Am J Clin Pathol 70:753-759, 1978; Cotelingam, Adv Anat Pathol 10:8-26, 2003; Lee et al., Int J Lab Hematol 30:349-364, 2008; Peterson et al., Arch Pathol Lab Med 126:1050-1056, 2002).
当同时检查外周血涂片、骨髓穿刺涂片、环钻活检印片、环钻活检及凝块活检切片时，可获得最大诊断信息。外周血涂片反映终末器官功能，并为潜在的血液淋巴系统病理学提供线索，这可能促使进行包括骨髓检查在内的其他研究。单独的骨髓穿刺在评估有限数量的原发性血液系统疾病时具有诊断价值，这些疾病包括：巨幼细胞贫血、再生低下性贫血、某些溶血性贫血、正色素正细胞性贫血、中性粒细胞减少症、血小板减少症、免疫球蛋白紊乱、贮积病和白血病（贝恩，《临床病理学杂志》54:657 - 663，2001年）。骨髓环钻活检适用于骨髓穿刺不成功的情况；用于评估血细胞减少症、骨髓纤维化、怀疑淋巴瘤、转移性肿瘤、肉芽肿性疾病、骨髓增殖性肿瘤，以及用于代谢性疾病中骨小梁的检查（贝恩，《临床病理学杂志》54:737 - 742，2001年）。许多骨髓穿刺的适应证与环钻活检的适应证重叠。由于无法预测哪些患者的穿刺活检具有诊断价值，哪些患者的环钻活检具有诊断价值，因此这两种检查通常一起常规进行（布赖恩斯等人，《美国临床病理学杂志》70:753 - 759，1978年；科特林厄姆，《解剖学病理学进展》10:8 - 26，2003年；李等人，《国际实验室血液学杂志》30:349 - 364，2008年；彼得森等人，《病理学与检验医学档案》126:1050 - 1056，2002年）。
