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Bone marrow aspirate collection and preparation--a comparison of three methods
Teresa DiFrancesco1, Duane J Boychuk, John D Lafferty
1Hamilton Regional Laboratory Medicine Program, St. Joseph's Hospital, Hamilton, Ontario. difrance@hhsc.ca
Purpose:
Preparing bone marrow smears using non-anticoagulated bone marrow aspirate is a traditional practice but many laboratories now use anticoagulated aspirate samples in K-EDTA. There are no published studies comparing the effectiveness of these two methods. This report compares the readability of slides, prepared using non-anticoagulated and anticoagulated methods, from three laboratories in Hamilton Ontario.
Methods:
A blinded set of 129 aspirate slides prepared using anticoagulated and non-anticoagulated methodologies (using K-EDTA) was reviewed by three reviewers. Slides were classified as unreadable if two of the three observers rejected them based on a standardized survey.
Results:
The proportion of slides classed as unreadable varied widely (5.0% to 46.9%) depending on collection and slide preparation methods. Degree of coagulation did not affect readability.
Conclusion:
A measurable advantage to using non-anticoagulated bone marrow was not demonstrated. Immediate anticoagulation of bone marrow samples, with laboratory personnel at the bedside to assess sample quality, followed by slide preparation in the laboratory provided the best results.
Insights
Bone marrow smear preparation methods were compared. Immediate anticoagulation with bedside assessment yielded the best results, showing no significant advantage for non-anticoagulated samples in this study.
Area of Science:
- Hematology
- Laboratory Medicine
- Diagnostic Pathology
Background:
- Traditional bone marrow smear preparation uses non-anticoagulated aspirate.
- Current laboratory practices increasingly utilize anticoagulated samples (K-EDTA).
- Limited published data exists comparing these preparation methods.
Purpose of the Study:
- To compare the readability of bone marrow slides prepared from anticoagulated versus non-anticoagulated aspirates.
- To evaluate the effectiveness of different slide preparation techniques across multiple laboratories.
Main Methods:
- A blinded review of 129 bone marrow aspirate slides was conducted.
- Slides were prepared using both anticoagulated (K-EDTA) and non-anticoagulated methods.
- Three independent reviewers assessed slide readability using a standardized survey.
Main Results:
- The percentage of unreadable slides varied significantly (5.0%–46.9%) based on collection and preparation methods.
- The degree of sample coagulation did not impact slide readability.
- No definitive advantage was found for using non-anticoagulated bone marrow aspirates.
Conclusions:
- Immediate anticoagulation of bone marrow samples at the bedside is recommended.
- Laboratory personnel assessing sample quality at the bedside improves results.
- Slide preparation in the laboratory following immediate anticoagulation provided optimal outcomes.
