President Clin-Path Associates, PLC

Fireman: Mr. Smith, at one point we decided to fight fire with fire….

 And, well…your house burned even faster!

The science of the causes and effects of diseases.

 The basic principle in pathology is pattern recognition.  Variations in each and every disease process make the basic principle part challenging.  There is an exception to each and every rule.  Good judgment is extremely helpful.

 Good judgment comes from experience, which mostly comes from bad judgment.  Will Rodgers

 “It ain’t what you don’t know that gets you in trouble; it’s what you know for sure that just ain’t so”.  Mark Twain

 Unexplained anemia, abnormal red cell indices, cytopenias or cytoses.  Abnormal peripheral blood smear morphology suggestive of bone marrow pathology.  Diagnosis, staging and follow-up of acute and chronic leukemias, myelodysplastic syndromes, chronic myeloproliferative disorders, lymphomas, plasma cell myeloma, amyloidosis, and mastocytosis.

 Suspected bone marrow metastases.  Focal bony lesions on radiological imaging.  Unexplained organomegaly or presence of mass lesions inaccessible for biopsy.  Fever of unknown origin.  Evaluation of iron stores.  Lipid/glycogen storage disorders.

 Core should be at least 1 cm in length.  Approximately 7 ml of aspirate is required to perform morphology, flow cytometry, fluorescence in situ hybridization (FISH), and cytogenetics.  EDTA tube is required for smears (do not use sodium heparin because of staining artifact).  Flow cytometry, FISH, and cytogenetics use sodium heparin tubes.

 Best to perform aspirate with Illinois needle.  Draw approximately 15 cm of vacuum.  Portion of aspirate can be squirted directly into formalin.

 Generally occurs in “packed” marrows, fibrotic marrows, or marrows with metastatic disease.  “Packed” marrows are generally acute or chronic leukemias with 100% cellularity.  Fibrotic marrows are generally myeloproliferative disorders, damaged marrows with fibrosis, or “Hairy cell” leukemia.

 Redirect Jamshidi before collecting bone core.

 When possible try to attain a consolidated report format (contains morphology, flow and FISH, and cytogenetics results).  Each testing type is less specific as a stand alone test, but combined become very powerful diagnostically.

 “Memories of what never was, become the good old days”  Steve Martin from the album “The Crow”