Maximizing the diagnostic yield from bone marrow aspirate material using the cell block technique on clot sections

Abstract

Background: Paraffin section of bone-marrow aspirate (clot section) is one of several components of bone marrow biopsy. Improper acquisition of aspirate material results in lack of diagnostic tissue and a waste of resources. Objective: To detail a novel cell block method of aspirated marrow as a way to ensure maximum yield. This is of particular value when the material gathered via core biopsy is inadequate. Method: We used the cell block method to evaluate paraffin-embedded sections of hematopoietic tissue from bone marrow aspirate. Results: The range of diagnoses possible from an adequate clot section parallels those from a comparable core biopsy. Examples of an adequate clot section include lesions assessed by routine hematoxylineosin (H&E) staining, special and immunohistochemistry (IHC) stains, and molecular diagnostic studies such as fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR). Conclusion: A bone marrow clot section comprised of sinusoidal blood is inadequate for morphological interpretation and is a waste of resources. Hence, we recommend the cell block technique for procurement; this method ensures maximum capture of material needed to establish a diagnosis.