Bone Marrow Aspiration & Biopsy

NAME OF PROCEDURE

Bone Marrow Aspiration and Biopsy

CPT CODE

  • 38221 – Bone marrow biopsy, needle or trocar
  • 88313 – Group II, all other, (e.g. iron, trichrome, reticulin fiber), except immunocytochemistry and immunoperoxidase stains
  • 38220 – Bone marrow aspiration only

88305 – Level VI – Surgical pathology, gross and microscopic examination.

  • Core biopsy or
  • Clot section

88311 – Decalcification procedure

APPLIES TO

Bone marrow aspirate, bone marrow biopsy, bone marrow smear

SPECIAL INSTRUCTIONS

To request a pathologist @Southeastern Pathology Associates for collection of the Bone Marrow Aspirate, complete and fax a <Request for Pathologist Attendance for Frozen Section or Special Procedures Form>.  Notify the lab as soon as possible when making this request (48 hours advance notice is preferred).

A current CBC with differential must be available for the pathologist to review.  Appropriate clinical history is essential to interpretation and should be received with the specimen.  Information regarding the type of specimen, admitting diagnosis, and pertinent clinical history (i.e. age, clinical impression, past diagnosis, radiographic findings, and history of radiation or chemotherapy) is essential to interpretation and should be noted on the requisition.

SPECIMEN CONTAINERS

  • Bone Marrow Core – in plastic capped container with 10% buffered formalin
  • Bone Marrow Clot – in plastic capped container with 10% buffered formalin, or sent fresh
  • Bone Marrow – at least 2ml; Lavender-top, Vacutainer tube (EDTA) for Flow Cytometry
  • Bone Marrow – at least 2ml; Green-top, Vacutainer tube (Sodium Heparin)  for Cytogenetics
  • Bone Marrow – at least 2ml; Lavender-top, Vacutainer tube (EDTA) for T-cell Gene Rearrangement
  • Bone Marrow culture – (if needed) aspirate, core, or clot, sent fresh in a sterile container

REQUEST FORM

Complete a <Department of Hematopathology – Bone Marrow Biopsy Information> OR, <Anatomical Pathology Requisition>.

CAUSES FOR REJECTION

Specimen containers not properly labeled

LIMITATIONS

Presence of normal or non-diagnostic marrow at one site may not exclude the possibility of disease elsewhere in the marrow.

ADDITIONAL INFORMATION

If a patient is suspected of having leukemia, the clinician may order a leukemia bone marrow evaluation.  1 – 3ml of bone marrow aspirate is placed in a sodium heparin (green-top) Vacutainer for T&B cell typing and cytogenetic work-ups.

Lymphomas are best diagnosed by lymph node examination, but once the diagnosis has been made it is often desirable to determine whether it has involved the bone marrow.

A bone marrow examination may be performed in order to look for evidence of lipid or glycogen storage disease.

Marrow study is important in the classification of a number of diseases involving the reticuloendothelial system, including the uncommon entity hairy cell leukemia.

Sometimes the material aspirated does not contain hematopoietic cells.  This condition, referred to as a “dry tap”, occurs when hematopoietic activity is so sparse there are virtually no cells to be withdrawn or when the marrow contains so many tightly packed, sticky, immature cells the routine suction cannot dislodge them.  In such instances a bone marrow biopsy must be performed for proper evaluation.

Bone marrow culture is sometimes helpful, for instance, in diagnoses of military tuberculosis and histoplasmosis, orders for appropriate cultures must accompany such samples, which require sterile containers.