Why are bone marrow aspiration and biopsy reports different?

Question

Hi doctor,

Bone marrow aspiration twice showed hypercellular bone marrow with overgrowth of WBC and megakaryocytes with all stages of maturation, including micro-megakaryocytes. But at the same time, the second BMA during bone marrow biopsy showed normocellular bone marrow.

Is something like that possible?
Can it be due to any mistake during the reading of the BMB sample? The doctor who made the BMA and BMB said that the patient has no fat in the bone marrow.
The health position of the patient is worsening, and the bone pain, fatigue, and abdominal pain are more and more intense. Can you explain this?

Kindly assist.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and can understand your concerns.

You have not mentioned the age of the patient, peripheral smear, and CBC (complete blood count) findings.
You mentioned that bone marrow was showing overgrowth of the WBC (white blood cells) and micromegakaryocytes. So, it is a myeloproliferative condition.
Here, clinical correlation is necessary. If it is in an infectious condition, then more WBC series cells will also be produced.
Bone pain, fatigue history, and micromegakaryocytes are present along with hypercellular bone marrow. Hence, myeloproliferative neoplasm or myelodysplasia needs to be ruled out.
For that, CBC, peripheral smear examination, and ESR (erythrocyte sedimentation rate) should be done first, along with liver, spleen, and lymph node palpation as primary workup.
The two consecutive bone marrow aspiration findings can be different if done with a long time interval in between.
If a bone marrow biopsy is done and sent for histopathology examination, then it is more confirmatory.
You can provide a bone marrow report and a CBC report as attachments along with other clinical histories for more comment.

Please let me know if I can assist you further.

Take care.