Browse
 
Dahl Chase Folders

Collection of Bone Marrow

Reference Number: AA-00427

SECTION THREE

Dahl-Chase Diagnostic Services

BONE MARROW

COLLECTION OF BONE MARROW

PURPOSE

 

To ensure standardized collection of bone marrows, smear preparation, paper work and delivery to the appropriate departments (ALI lab, ARUP, and DCDS Pathology and Flow Cytometry).

           

Test

Specimen

Forms and other

Send to

Pathology

Core in B Plus

Clot in B Plus

Smears on cardboard tray

1.  Hematopathology requisition

2.  Face sheet

3.  most recent CBC

Dahl-Chase (Webber West 5th floor)

Flow Cytometry

1-2cc in Na Heparin

Cytogenetics/ FISH

 

Add 1-2cc marrow to white label black-capped tube Invert several times.

Add 0.5-1cc marrow to pink label black-capped tube. Invert several times.

1. Hematopathology requisition

2. ARUP Cytogenetics History Form

Culture (bacterial, and fungal

1-1.5cc in pediatric isolator tube (yellow top mini tube)

ALI Requisition form

Deliver immediately to ALI Lab (Webber West / 2ndfloor)

AFB

1-2cc in Na Heparin Tube

ALI Requisition form

Viral culture

EDTA Tube (lavender)

JAK-2

1-3ml of bm in  EDTA

 

FLT3, NPM1, CEBPA, KIT

1-3ml of bm in one EDTA (purple top) or

2 EDTA tubes of peripheral blood.

 

 

 

 

 

 

 

 

BONE MARROW COLLECTION PROCEDURE:

 

Check paperwork

 

1.     Complete the bone marrow section of the ‘Hematopathology’ requisition form (for core, clot, slides) and face sheet.  Fill out how many slides you have made,” and check off the proper boxes indicating you rec’d a core, clot, aspirate, etc.  If the core biopsy was unsuccessful then you would note next to the box “no core.” Same thing with the aspirate and clot. 

 

2.     If requested, complete the ‘Flow Cytometry’ section of the Hematopathology requisition form (green top tube):  COPY OF CBC IS NEEDED.

3.     You have the option of ordering specific FISH testing or checking the box for "Comprehensive Hematopathology consultation" that allows the hematopathologists to select the appropriate tests based upon specimen adequacy and clinical indication.   

4.     If cytogenetics is requested, check the Chromosome Analysis/Cytogenetics box on the requisition (white labeled black top tube); Make sure all patient information has been documented on the req and ARUP cytogenetics history form, include date/time/initial. Remember to put the patient’s diagnosis or suspected diagnosis on the ARUP Cytogenetics history form.

 

Verify that slides are labeled correctly with:

1.    Patient’s last name and first name

2.    MR # or DOB

3.    Tissue source (bone marrow)

 

Verify information on 5 labels for core, clot, flow and 2 cytogenetics tubes

 

1.     Non-heparinized syringe:

1.     Pour bone marrow over angled slide

2.     Collect bone marrow with spicules for 3 push and 5 crush smears

3.     Two crush and one push smear to be stained later at DCDS Flow Cytometry for the pathology evaluation

4.     Two crush and two push smear to be kept unstained

5.     One of the crush smears is used for the iron staining (performed at DCDS Histology)

                                          i.    Let remaining bone marrow in syringe clot and place in B Plus container

                                        ii.    If the bone marrow does not clot after 10-15 minutes, empty syringe into the B Plus container

 

 

Advantages

Disadvantage

Direct push smears

Morphology excellent

Staining uniform

Accurate diff

May be diluted with blood, causing skew in cell counts

Particle crush smears

Close concentration of particles useful for assessment of megakaryocytes, macrophages, mast cells and cancer cells.

Best for iron stain

Many cells may be broken or distorted

Uneven cell dispersal and uneven staining (under-stained think areas

 

2.     Heparinized syringe

1.    Pour 1-2cc in "white label" black top tube (minimum 0.5cc) and mix

2.    Pour 1-2cc in green top tube (minimum 0.5cc) and mix

3.    Pour 0.5-1cc in "pink label" black top tube (minimum 0.5cc) and mix.

4.    Other studies if needed

 

 

3.     Core biopsy

1.    Place core on 1st slide

2.    Hold 2nd ,3rd and 4thslides upside down to make touch preps

3.    Submit slides 2, 3 and 4 as touch preps, discard slide1

4.    Place core in B Plus container

 

Important: If dry tap (no aspirate obtained), it would be preferable to obtain additional core biopsies:

·        Make 4 extra touch preps

·        Place all core biopsies into RPMI tube for flow cytometry.  Flow Cytometry will recover the cells from the core and place the remainder of the core into fixative

·        Transport to the ALI, DCDS ASAP

 

Call flow cytometry at 941-8282 to notify them if you are sending a marrow for flow.  Make sure that paperwork is complete and send pathology and flow cytometry specimen to Dahl-Chase Diagnostic Services and cytogenetics specimen to ALI. A recent peripheral blood smear and CBC data should also be included, with the bone marrow specimen.

 

Weekend and After Hours:

 

1.    Sample processing hours at DCDS are Monday-Friday 6:00am-9:00pm and on call weekends for bone marrows from 10:00am-3:00pm

2.    Routine pathology:  Hold in send out department for transport to DCDS (Webber West, 5th floor) on Monday morning.

3.    Rapid Pathology and specimens needing flow cytometry:  Page the on-call DCPA pathologist (973-7000) who will evaluate the order and contact the Flow Cytometry lab if necessary.  A stat courier will need to be called if the specimen has missed the pick-up by UniShip that day.  In this case, please work with the pathologist or flow cytometry tech to arrange pick-up.

4.    Cytogenetics:  Send to ALI for ARUP pick-up or arrange ARUP pick-up yourself

 

Supplies:

1.  For all Pathology, Flow Cytometry and Cytogenetic supplies, please call (207) 941-8202

.