What is the role of bone marrow aspiration and biopsy in the diagnosis of aplastic anemia?

Updated: Jan 29, 2021
  • Author: Sameer Bakhshi, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Bone marrow biopsy is performed in addition to aspiration to assess cellularity qualitatively and quantitatively. Aspiration samples alone may appear hypocellular because of technical reasons (eg, dilution with peripheral blood), or they may appear hypercellular because of areas of focal residual hematopoiesis. By comparison, core biopsy better reveals cellularity. A trephine biopsy of at least 2 cm is essential to assess overall cellularity and morphology of residual hemopoietic cells and to exclude abnormal infiltrates.

In aplastic anemia, hypocellular marrow particles are observed. The specimen is considered hypocellular if it is less than 30% cellular in individuals younger than 60 years or less than 20% cellular in those older than 60 years (see the following image). Some dyserythropoiesis with megaloblastosis may be observed in aplastic anemia. Focal hyperplasia of erythroid cells may sometimes be observed, in the background of generalized hypocellularity. Small aggregates of lymphoid cells may also be observed in few conditions (autoimmune diseases).

Aplastic anemia. Low-power view of hematoxylin-eos Aplastic anemia. Low-power view of hematoxylin-eosin–stained bone marrow showing hypocellularity, with increased adipose tissue and decreased hematopoietic cells in the marrow space.

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