237 Findings From BONE Marrow Biopsy Pathology Show Plasma CELL Disorders Have Smaller CORE Lengths; Mastocytosis, Myeloproliferative Disorder, and Chronic Lymphocytic Leukemia Have Higher Hemodilution Rates

Track: Contributed Abstracts
Wednesday, February 13, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Vance Ward, RN, BSN , Washington University Medical Center, St. Louis, MO
Barbara Press, RN, BSN, OCN , Medicine, Washington University, St. Louis, MO
Jim Wischmeier, RN, BSN, OCN , Medicine, washinton University, St. Louis, MO
Patty Cliver, RN, OCN , Washington University
Kelly Garavaglia, RN , Washington University
Cheryl Wilson, RN, BSN, OCN , Washington University
Greg Voelkel, RN, BSN , Washington University
Charles Eby, MD , Washington University
Background:  After performing thousands of bone marrow biopsies(BMX), our nurse lead biopsy staff started identifying what is likely intuitively known about specific diseases and their BMX characteristics.   We began collecting data both on core lengths and hemodilution rates to see if our data validates our suspicions that patients with plasma cell dyscrasias(PCD) have significantly smaller core lengths and myeloproliferative disorders(MPD) have significantly higher hemodilution rates. 

Methods: This was a chart review from pathology reports on 3199 patients with BMX’s performed at Siteman Cancer Center between January 1st 2006 and December 30th 2011.  A convenience sample of patients having their BMX at our center was utilized.  We reviewed patients BMX results a week following the BMX procedure to monitor job performance of the BMX staff.  Data collected included diagnosis, gross bone marrow core length, evaluable bone marrow core, and pathology reported bone marrow aspirate hemodilution.  For this review PCD included MM, Monoclonal gammopathy of undetermined significance (MGUS), and Amyloidosis.  MPD included Chronic Myeloid Leukemia(CML), Polycythemia Vera(PV), and Myelofibrosis(MF). 

Results:   Our data showed that the mean bone marrow core length among all samples was 1.9 centimeters (cm) with the average evaluable bone marrow core length being 1.3 cm.  Mean PCD bone marrow core length was found to be much lower at 1.6 cm with evaluable core length of 1.1 cm.  Our mean hemodiluted bone marrow aspirates rate was 12.2%.  The percent of CLL hemodiluted bone marrow aspirate was 15.4% which included 2 dry taps and MPD was 17.3% and included 1 dry tap.  Of interest, the percent of hemodiluted samples seen in patients with Mastocytosis was 55.6%.  In reviewing our data, we noted that only 19 of 3199 patients had a dry tap which seems quite low.  It is our thought that this is a reflection of the patient population we treat.  Most of the newly diagnosed AML’s have their BMX in the hospital.  See chart for full data compilation. 

Conclusion: In our review, it appears that plasma dyscrasias have a bone marrow core less than the average reviewed and CLL, MPD, and Mastocytosis have a higher hemodilution rate in comparison.  We are going to review the data further to see if differences can be seen in older vs. younger patients.
  TOTAL  ALL AA AML CLL MPD HD MDS Masto PCD NHL Other
Total Bone Marrow Biopsies 3199 170 54 965 125 215 78 317 32 598 508 137
Average Core in Centimeters 1.9 1.9 1.9 1.9 1.9 1.9 2.0 1.8 2.0 1.6 2.0 1.9
Average Evaluable Core in CM. 1.3 1.4 1.4 1.3 1.4 1.3 1.6 1.3 1.5 1.1 1.6 1.3
%  per Captured 41.1% 5.3% 1.7% 30.2% 3.9% 6.7% 2.4% 9.9% 1.0% 18.7% 15.9% 4.3%
% Hemodiluted per Aspirates 12.2% 9.4% 11.9% 12.3% 15.4% 17.3% 7.8% 10.2% 55.6% 9.1% 6.7% 15.7%
Drytab 19 0 0 3 2 1 1 2 1 5 3 1

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