Lesson 1Indications and specimen types: bone marrow aspirate vs core biopsy and when both are requiredReviews clinical indications for marrow examination and compares aspirate and core biopsy specimens, explaining their complementary roles, limitations, and scenarios where both are needed for accurate diagnosis and staging.
Common indications for marrow examinationDiagnostic value of marrow aspirate smearsRole of trephine core biopsyWhen both aspirate and core are requiredLimitations and pitfalls of each specimenLesson 2Flow cytometry vs morphology vs immunohistochemistry: when to use each and how results complement each otherCompares morphology, flow cytometry, and immunohistochemistry in marrow evaluation, outlining indications, strengths, and limitations of each, and how integrated interpretation improves lineage assignment and disease classification.
Indications for flow cytometry in marrowMorphologic assessment of marrow smearsRole of immunohistochemistry on core biopsiesChoosing tests based on clinical questionIntegrating multimodal results in reportsLesson 3Correlation of marrow findings with peripheral blood: criteria for diagnosing aplastic anaemia, myelodysplastic syndromes, acute leukaemia, and marrow infiltrationExplains how to correlate marrow findings with peripheral blood, applying integrated criteria to diagnose aplastic anaemia, myelodysplastic syndromes, acute leukaemias, and marrow infiltration by solid tumours or lymphomas.
Peripheral smear review in marrow workupCriteria for aplastic anaemia diagnosisMarrow and blood features of MDSAcute leukaemia diagnostic integrationPatterns of marrow infiltration by tumoursLesson 4Urgent reporting and communication for marrow findings: communicating high blast counts, marrow failure or metastatic infiltration to clinical teamsFocuses on rapid recognition and communication of critical marrow findings such as high blast counts, severe hypocellularity, and metastatic infiltration, defining escalation pathways, documentation, and communication with treating teams.
Defining critical marrow result thresholdsRapid verification of urgent findingsDirect communication with clinical teamsDocumenting critical value notificationsFollow-up reporting after urgent callsLesson 5Core biopsy processing: fixation, decalcification methods, paraffin embedding, sectioning and H&E stainingExplains stepwise handling of marrow core biopsies from fixation through decalcification, embedding, microtomy, and H&E staining, emphasising artefact prevention, morphology preservation, and standardisation of histologic quality.
Fixatives for marrow core biopsiesDecalcification agents and endpointsParaffin embedding orientation of coresSection thickness and microtomy artefactsHaematoxylin-eosin staining optimisationLesson 6Pre-analytical handling of marrow specimens: labelling, anticoagulant choice, transport, decalcification needs, and fixationDetails pre-analytical steps for marrow aspirates and cores, including labelling, anticoagulant selection, transport conditions, fixation timing, and decalcification planning to preserve morphology, antigens, and nucleic acids for testing.
Patient identification and specimen labellingChoice of anticoagulant for aspiratesTransport temperature and time limitsFixation timing for cores and clotsPlanning decalcification for downstream testsLesson 7Analytical quality measures in histology: control tissues, reagent validation, turnaround time monitoring, and slide review protocolsDescribes analytical quality systems in marrow histology, including use of control tissues, reagent validation, equipment maintenance, turnaround time tracking, and systematic slide review protocols to ensure reliable, reproducible results.
Selection of appropriate control tissuesReagent validation and lot-to-lot checksEquipment maintenance and calibrationTurnaround time targets and auditsPeer and double-slide review processesLesson 8Special stains and adjunct tests on marrow: reticulin (Gomori), iron stains (Prussian blue), immunohistochemistry panels and interpretationCovers selection, performance, and interpretation of marrow special stains and adjunct tests, including reticulin and collagen fibrosis grading, iron assessment, and targeted immunohistochemistry panels for neoplastic and reactive conditions.
Reticulin and collagen fibrosis gradingIron stores and ring sideroblast assessmentCytochemical stains in marrow evaluationCore immunohistochemistry lymphoma panelsIHC markers for myeloid and blast lineageLesson 9Reporting marrow results: cellularity assessment, lineage distribution, dysplasia, blast count, fibrosis grading, and structured report elementsOutlines structured marrow reporting, including assessment of cellularity, lineage distribution, dysplasia, blast percentage, fibrosis grade, and integration of ancillary tests, ensuring clear, standardised, clinically actionable reports.
Estimating and reporting cellularityDescribing lineage distribution and ratiosDocumenting dysplasia and blast countsReporting fibrosis grade and iron statusIntegrating ancillary test results in summary
