Dry tap on bone marrow aspiration: a red flag

Abstract

A dry tap obtained on bone marrow aspiration is considered a failure to aspirate marrow particles. However, it is often related to an underlying bone marrow pathology that hinders successful aspiration of hematopoietic cells. In this retrospective analysis, 2768 bone marrow aspirates and trephine biopsies were reviewed. Of these, 223 patients with bone marrow aspirations which yielded no marrow particles (dry tap) were included in the study. Patients in whom adequate trephine biopsy could not be obtained were excluded from the study. The final diagnosis was made by studying the trephine biopsy and correlating it with other ancillary investigations. Of the 2768 bone marrow aspirations studied, dry tap was seen in 223 (8.0%) patients. Of these, 209 (93.7%) patients had an underlying bone marrow pathology while 14 (6.3%) patients had dry tap due to faulty technique. Hematological malignancies were seen in 164 (73.5%) patients, benign hematological disorders in 33 (14.9%) patients while 4% patients had non-hematological disorders. Among hematological malignancies, leukemia (acute and chronic) was the commonest cause of a dry tap seen in 40.3% of the patients. Dry tap obtained on bone marrow aspiration should serve as a red flag for the hematologist rather than a failed procedure. In most cases, it indicates the possibility of underlying bone marrow pathology. Trephine biopsy should always be studied in such cases.