Bone Marrow Aspiration and Biopsy
Proper collection and preparation of bone marrow is critical to the study of a variety of hematologic and neoplastic disorders. A bone marrow profile includes a CBC, manual differential, and a reticulocyte count. Please send an EDTA whole blood specimen for this testing. Never send a dry Bone Core sample as it will desiccate and be useless for any study, including slides/morphology. For a printable Bone Marrow and Cytogenetics form refer to the link below for the Oncology work-up requisition.
Download the following helpful documents
Oncology Work-up Requisition
Bone Marrow Collection Form
Bone Marrow Collection Quick Reference Visual Guide.
Aspirate - Smears
- Place 2 mL of aspirate into a 2.7 mL light blue Sodium Citrate (3%) tube and mix thoroughly. Heparin or EDTA anticoagulants should NOT be used since they may produce staining artifacts.
- Prepare 8-10 pull prep slides from the anticoagulated aspirate. Send the remaining citrated aspirate to the laboratory. Alternatively, send the entire citrated aspirate to the lab ASAP for preparation of smears.
Aspirate – Additional testing (Flow Cytometry, Cytogenetics, Chromosomes, PCR & Microbiology)
- Place at least 2-3 ml of aspirate into each of the following tubes for additional testing:
- One Lavender EDTA tube for Flow Cytometry and Molecular testing.
- One Dark green sodium heparin, no gel tube for Chromosome studies.
- If cultures have been requested on the bone marrow, also add 2 mL of aspirate into a Yellow SPS tube or Wampole Isolator tube.
- Invert the tubes several times to allow for proper specimen and anticoagulant mixing.
- Pre-authorization for cytogenetic and molecular testing should be obtained. Include a signed Advanced Beneficiary Notice with this testing request.
Clot (for Histology Sections)
- Allow remaining aspirate to clot in syringe. Slowly remove plunger and clot from syringe.
- Place clot in a sterile screw top cup containing 10% buffered formalin. Use enough formalin to cover the specimen.
Bone Biopsy and Touch Preparations
- If an aspirate has been obtained, place the core biopsy in a sterile cup and cover with 10% buffered formalin.
- If there is a dry tap and the physician obtains only a core biopsy, a generous biopsy or several smaller biopsies should be obtained to allow complete testing.
A. Touch preparations should be made using the biopsy, removing as much blood as possible prior to making touch preps. Prepare 6-8 touch prep slides by touching, not pressing, the biopsy to clean slides. Make sure slides are properly labeled with the patient name and DOB, in pencil.
B. The core biopsy specimen(s) should then be divided or sectioned for additional testing (e.g. Flow and/or Chromosomes), and separate pieces should be placed into the following:
- One Piece in a sterile cup, covered in 10% formalin for histology.
- One Piece in a sterile cup, covered in RPMI for Flow.
- One Piece in RPMI for Cytogenetics.