president clin-path associates, plc. fireman: mr. smith, at one point we decided to fight fire with...

PHILIP R. ZOLLARS, M.D.

PresidentClin-Path Associates, PLC

Fireman: Mr. Smith, at one point we decided to fight fire with fire….

Fireman: Mr. Smith, at one point we decided to fight fire with fire….

And, well…your house burned even faster!

Pathology:

Pathology:

The science of the causes and effects of diseases.

Pathology:

The basic principle in pathology is pattern recognition.

Variations in each and every disease process make the basic principle part challenging.

There is an exception to each and every rule.

Good judgment is extremely helpful.

Pathology:

Good judgment comes from experience, which mostly comes from bad judgment.

Will Rodgers

Pathology:

“It ain’t what you don’t know that gets you in trouble; it’s what you know for sure that just ain’t so”.

Mark Twain

PathologyFree-time

PathologyFree-time

PathologyFree-time

Bone Marrow Biopsies

Bone Marrow BiopsyIndications

Unexplained anemia, abnormal red cell indices, cytopenias or cytoses.

Abnormal peripheral blood smear morphology suggestive of bone marrow pathology.

Diagnosis, staging and follow-up of acute and chronic leukemias, myelodysplastic syndromes, chronic myeloproliferative disorders, lymphomas, plasma cell myeloma, amyloidosis, and mastocytosis.

Bone Marrow BiopsyIndications

Suspected bone marrow metastases. Focal bony lesions on radiological

imaging. Unexplained organomegaly or presence

of mass lesions inaccessible for biopsy. Fever of unknown origin. Evaluation of iron stores. Lipid/glycogen storage disorders.

Bone Marrow Procedure

Bone Marrow Procedure

Bone Marrow Procedure

Bone Marrow ProcedureSpecimen Adequacy

Core should be at least 1 cm in length. Approximately 7 ml of aspirate is required

to perform morphology, flow cytometry, fluorescence in situ hybridization (FISH), and cytogenetics.

EDTA tube is required for smears (do not use sodium heparin because of staining artifact).

Flow cytometry, FISH, and cytogenetics use sodium heparin tubes.

Bone Marrow ProcedureSpecimen Adequacy

Best to perform aspirate with Illinois needle.

Draw approximately 15 cm of vacuum. Portion of aspirate can be squirted

directly into formalin.

Bone Marrow ProcedureSpecimen Adequacy

Bone Marrow ProcedureClot Section Comparison

Bone Marrow Procedure“Dry Tap”

Generally occurs in “packed” marrows, fibrotic marrows, or marrows with metastatic disease.

“Packed” marrows are generally acute or chronic leukemias with 100% cellularity.

Fibrotic marrows are generally myeloproliferative disorders, damaged marrows with fibrosis, or “Hairy cell” leukemia.

Bone Marrow Procedure

Redirect Jamshidi before collecting bone core.

Bone Marrow Report

When possible try to attain a consolidated report format (contains morphology, flow and FISH, and cytogenetics results).

Each testing type is less specific as a stand alone test, but combined become very powerful diagnostically.

“Memories of what never was, become the good old days”

Steve Martin from the album “The Crow”

The End!