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 maturing 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 BMA and BMB told that the patient has no fat in the bone marrow. The health position of the patient is worsening, the bone pain, fatigue, and abdominal pain are more and more intensive. Can you give an explanation for this?

Answer 1

Hi,

Welcome to icliniq.com.

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 micro megakaryocytes. So, it is a myeloproliferative condition.
Here, clinical correlation is necessary. If it is in an infective condition, then also more WBC series cells will be produced.
Bone pain, fatigue history, and micro megakaryocytes 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 confirmative.
You can provide a bone marrow report and CBC report as an attachment along with other clinical histories for more comment. Take care.