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TABLE 1

Analyse of the BM biopsy.
Guidelines.

• Size / quality of the biopsy
• Bone trabeculae (thickness, modifications)
• Cellularity according to age (see below)
• Haemopoietic cell lines (representation, distribution, maturation)
• Reactive cells: lymphocytes, plasma cells, histiocytes and mast cells (quantity, distribution, morphology)
• Quantification of BM reticulin and collagen according to Bauermeister (see below)
• Iron stores
• Abnormal cells: blasts or lymphoma or myeloma or metastatic cells
• Specific lesions: granulomas, necrosis, amyloidosis, serous atrophy
• Immunohistochemistry results if available
• Diagnosis, interpretation and comments

Assessment of cellularity in daily practice.  
In adults (30 - 60 yr-old), a 50 % cellularity may be viewed as normal; cellularity of less than 25 % indicates hypoplasia and more than 75 % hyperplasia. The BM in neonates is extremely cellular and cellularity declines steadily with age.
The cellularity is expressed as percentage of the marrow cavity.
Caution! Adequate size necessary! A small biopsy containing only a small amount of subcortical marrow does not allow assessment of cellularity (this area can be of low cellularity in normal subjects)


Assessment of BM reticulin ("marrow fibrosis") according to Bauermeister (1971) .

0 : No reticulin fibres demonstrable
1 : Occasional fine individual fibres and foci of a fine fibre network
2 : Fine fibre network throughout most of the section, no coarse fibres
3 : Diffuse fibre network with scattered thick coarse fibres but no mature collagen
4 : Diffuse often coarse fibre network with areas of collagenization

0 and 1 can be viewed as normal.

The term "myelofibrosis" should be restricted to the myeloproliferative disease . Although a significant percentage of patients with BM fibrosis have MPDs, lymphoproliferative disorders and metastatic tumours together account for a greater number. Inflammatory diseases may also result in marrow fibrosis (e.g. HIV infection). The term marrow fibrosis should be used for the non - specific reaction associated with a variety of disorders.

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Copyright 2001, The Author(s) and/or The Publisher(s)

Organisation: FORPATH asbl

Coordination: Dr Bernard Van den Heule

Host: Labo CMP