Bone marrow aspiration is a common diagnostic technique for hematologic disorders, with several tests including cytology, protozoa, and bacteriology. It is indicated for:
- Diagnosis, differential diagnosis and therapeutic follow-up of various hematologic disorders;
- Unexplained increased or decreased red blood cell, white blood cell and platelet counts and morphological abnormalities;
- Diagnosis and differential diagnosis of unexplained fever, with the possibility of bone marrow culture and bone marrow smear to look for parasites, etc.
Bone marrow aspiration and bone marrow biopsy are the gold standard for the diagnosis of leukemia. In general, patients with suspected leukemia need to have a bone marrow aspiration and bone marrow biopsy completed for diagnosis. When a bone marrow aspiration suggests the absence of leukemia, leukemia cannot be completely ruled out and the results of a bone marrow biopsy are still awaited because:
- First, the result of the bone marrow aspiration is related to the sampling site. When the bone marrow at the sampling site happens to be low in “leukemic cells,” the diagnosis of leukemia may not be reached. In addition, there is a high risk of dilution during the bone marrow puncture, where peripheral blood is mixed with the bone marrow fluid, which can affect the outcome.
- Second, if a patient carries certain typical leukemia mutations, fusion genes, or chromosomal changes, but does not develop the disease at this time, the bone marrow tap result may also be negative. In this case, routine blood and bone marrow images need to be reviewed regularly to clarify the disease in a timely manner.
- There is also myeloid sarcoma, a specific subtype of leukemia that presents as an extramedullary mass with a normal bone marrow.