Bone marrow aspirate and trephine
What the aspirate and trephine each show, who needs a marrow and who doesn't, how to read a report from cellularity to blasts, plasma cells, iron and fibrosis, and the mimics that fool it.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Two samples from the posterior iliac crest: the aspirate (liquid marrow for cells) and the trephine (a solid core for architecture).
- Indications: unexplained cytopenias, suspected leukaemia, MDS, myeloma, MPN, staging lymphoma when PET won't do, and fever or infection with an infiltrative picture.
- A report is read in order: adequacy, cellularity, lineages, blasts, plasma cells, megakaryocytes, iron, fibrosis, infiltrates, then the ancillary tests.
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Sources
- ICSH guidelines for the standardization of bone marrow specimens and reportsLee SH et al., International Council for Standardization in Haematology, Int J Lab Hematol 2008;30:349-64, 2008
- RCPA Manual (bone marrow aspirate and trephine)AU/NZRoyal College of Pathologists of Australasia
- The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: myeloid and histiocytic/dendritic neoplasmsKhoury JD et al., Leukemia 2022;36:1703-19, 2022
- International Consensus Classification of myeloid neoplasms and acute leukemias: integrating morphologic, clinical, and genomic dataArber DA et al., Blood 2022;140:1200-28, 2022
- Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELNDöhner H et al., Blood 2022;140:1345-77, 2022
- International Myeloma Working Group updated criteria for the diagnosis of multiple myelomaRajkumar SV et al., Lancet Oncol 2014;15:e538-48, 2014
- Guidelines for the diagnosis and management of adult aplastic anaemia: a British Society for Haematology guidelineKulasekararaj A et al., Br J Haematol 2024;204:784-804, 2024
- Bone marrow biopsy morbidity: review of 2003Bain BJ, J Clin Pathol 2005;58:406-8, 2005
- Last updated
- 14 November 2026
What changed
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