Bone Marrow Examination
BME aspirate and trephine biopsy — haematological diagnosis
Arun Singh, 38M — UHID: UH-2026-0844
Procedure: 08 Jun 2026 · Site: Posterior iliac crest (aspirate + trephine biopsy) · Indication: AML induction assessment — Day 14 bone marrow evaluation · Clinician: Dr. R. Mehta (Haematology)
AML — Residual Disease (42% Blasts)
| Component | Result | Normal | Interpretation |
|---|---|---|---|
| Cellularity | Hypercellular (90%) | 40-60% | Markedly increased — consistent with AML |
| Myeloid : Erythroid ratio | 8:1 | 3:1 to 5:1 | Increased myeloid predominance |
| Blasts | 42% (immunophenotyping positive for CD33, CD117, MPO) | < 5% | AML confirmed (>= 20% blast threshold). NPM1+ FLT3-ITD− (favourable-intermediate) |
| Erythropoiesis | Decreased, normoblastic | Normal maturation | Suppressed by blast infiltration |
| Megakaryocytes | Reduced, some dysplastic forms | Normal number and morphology | Thrombocytopenia explained |
| Reticulin fibrosis | Grade 1 (focal) | Grade 0 | Mild — not a primary MF |
| Special stains (PAS, MPO) | MPO positive (blasts) | MPO negative in normal blasts | Myeloid lineage confirmed |
Conclusion: Day 14 bone marrow shows persistent AML with 42% blasts — no complete remission (CR requires < 5% blasts). NPM1 positive, FLT3-ITD negative (standard risk). Recommend: proceed to salvage chemotherapy (FLAG-Ida or HiDAC-based). Repeat BME post-salvage cycle. Discuss allogenic stem cell transplant (alloSCT) in first CR.