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Estimation of cell density to aid in assessment of percentage cells of a particular lineage or of cells expressing a specific antigen in bone marrow trephine biopsies
  1. Saeed Al-Shieban1,2,
  2. Paul J Tadrous3,
  3. Kikkeri N Naresh1
  1. 1Department of Histopathology, Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust, London, & Imperial College London, UK
  2. 2Department of Pathology, King Abdulaziz Medical City, National Guard Health Affair, Riyadh, Saudi Arabia
  3. 3Department of Histopathology, Northwick Park Hospital, London, UK
  1. Correspondence to Professor Kikkeri N Naresh, Haematopathologist, Department of Histopathology, Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust and Imperial College, Du Cane Road, London W12 0HS, UK; k.naresh{at}


The authors aimed to develop a tool to assess total cell numbers in a microscope's field of vision, which would provide the denominator for calculating the percentage of positive cells for a given antigen in bone marrow trephine biopsies (BMTBs) of varying cellularities. Precise estimates of cell densities were made from 179 images of BMTBs of varying cellularities using a cell-counting software. The estimates were then validated on an independent set of 20 BMTBs. Among the 179 images, there was a strong linear association between marrow cellularity and cell numbers (Pearson correlation: 0.788). Then standardised cell densities (cells/mm2 of bone marrow) were deduced for BMTBs of varying cellularities. In the validation study, the actual and the estimated cell numbers correlated strongly (Pearson correlation: 0.990). The cell density estimates provided in this study can be adapted for any microscope and the same method can be used for calculation of the percentage-positive cells for any antigen.

  • Cell counting
  • bone marrow trephines
  • immunohistochemistry
  • Hodgkin's disease
  • haemato-oncology
  • lymphoma
  • MALT-lymphoma
  • virology
  • colorectal cancer
  • gall bladder
  • oncogenes
  • p53
  • pancreas
  • leukaemia
  • polycythaemia
  • erythrocyte
  • haematology
  • myeloproliferative disease

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.