Table 2

Indications for a bone marrow aspiration with or without a trephine biopsy and relevance of other techniques applicable to the aspirate

IndicationNeed for a trephine biopsyNotes on other useful investigations
*Unless there is difficulty obtaining a good aspirate.
†Because Epstein-Barr virus related haemophagocytic syndrome may be associated with a clonal proliferation of neoplastic T cells.
MDS, myelodysplastic syndrome.
Investigation of unexplained microcytosisOnly if MDS is suspected
Investigation of unexplained macrocytosisOnly if MDS is suspectedDeoxyuridine suppression test may be useful but is mainly a research technique
Investigation of unexplained anaemiaUsuallyCytogenetic analysis if MDS is suspected; ultrastructural examination if congenital dyserythropoietic anaemia is suspected
Investigation of unexplained thrombocytopeniaOnly if MDS is suspected
Investigation of pancytopenia (including suspected aplastic anaemia)YesCytogenetic analysis if MDS is suspected; appropriate culture if mycobacterial infection or leishmaniasis is suspected; bone marrow is a useful source of DNA if investigation for Pearson's syndrome is required; cytogenetic analysis if a haemophagocytic syndrome is suspected†
Investigation of a leucoerythroblastic blood film and suspected bone marrow infiltrationYesCytogenetic analysis if a haematological neoplasm is suspected; if an abnormal infiltrate is found, immunophenotyping and cytogenetic analysis may be useful; cytogenetic analysis is indicated if a small cell tumour of childhood is suspected because the demonstration of certain specific cytogenetic abnormalities can confirm the diagnosis
Investigation of suspected acute leukaemiaNo*Cytogenetic and possibly molecular genetic analysis; immunophenotypic analysis unless cells are clearly myeloid
Assessment of remission status after treatment of acute leukaemiaNo*Follow up cytogenetic analysis is only occasionally useful; molecular genetic analysis may be indicated for assessment of minimal residual disease
Investigation of suspected MDS or myelodysplastic/ myeloproliferative disorderYesCytogenetic analysis; investigation of colony forming units if juvenile myelomonocytic leukaemia is suspected
Investigation of suspected chronic myeloid leukaemiaNo*Cytogenetic analysis; molecular genetic analysis is not indicated because it can be performed, when necessary, on peripheral blood cells
Follow up of chronic myeloid leukaemiaNoCytogenetic analysis
Investigation of suspected myeloproliferative disorder (polycythaemia rubra vera, essential thrombocythaemia, idiopathic myelofibrosis, or systemic mastocytosis)YesCytogenetic analysis; investigation of colony forming units (erythropoietin independent burst forming units) may be useful but in most centres is not a routine diagnostic test
Investigation of chronic lymphocytic leukaemiaYesImmunophenotyping is not indicated because it can be performed easily on the peripheral blood
Investigation of suspected non-Hodgkin's lymphomaYesIf an abnormal infiltrate is present, immunophenotyping, molecular analysis and cytogenetic analysis may be needed
Diagnosis and follow up of hairy cell leukaemiaYesImmunophenotyping, unless there are sufficient circulating cells for it to be performed on peripheral blood cells; tartrate resistant acid phosphatase stain if detailed immunophenotyping is not available
Staging of low grade non-Hodgkin's lymphoma (if the results of investigation will alter management)YesImmunophenotyping, unless there are sufficient circulating cells for this to be done on blood cells; cytogenetic and molecular genetic analyses are sometimes useful if the specific type of non-Hodgkin's lymphoma has not already been determined
Investigation of multiple myelomaGenerally indicatedCytogenetic analysis may be useful because demonstration of poor prognosis abnormalities may influence management; immunophenotyping is only needed if cytology of the aspirate is not diagnostic and if it is not certain whether or not a monoclonal plasma cell population is present
Staging of high grade non-Hodgkin's lymphoma (in those cases where results of the investigation will alter management)Yes
Investigations of suspected storage diseaseNot essential
Investigation of fever of unknown originYesCultures for mycobacteria and also, if there is a possibility of previous exposure, for leishmania and histoplasma
In suspected chromosomal disorders in neonates when rapid confirmation is requiredNoCytogenetic analysis (may produce results in 1 day cf. several days if cultured peripheral blood lymphocytes are used)
Confirmation of normal bone marrow if bone marrow is being aspirated for allogeneic transplantationNo