APIMC223889221 - CME/CMLE - Bone Marrow Contamination in Cerebrospinal Fluid-APIMC223889221

APIMC223889221 - Educational Activity

Pdf Summary

This educational commentary, authored by Dr. Padmini A. Manrai, discusses the identification and implications of bone marrow contamination in cerebrospinal fluid (CSF) specimens. This information is provided in collaboration with the American Proficiency Institute and the American Society for Clinical Pathology (ASCP) to educate participants on recognizing contamination and the various stages of myeloid cell maturation.<br /><br />Key learning outcomes include identifying the features of bone marrow contamination in CSF, differentiating myeloid stem cell lineages, and understanding the morphologic characteristics of myeloid maturation stages. The commentary highlights a case involving a 76-year-old male with stage IV diffuse large B-cell lymphoma undergoing chemotherapy, which included the administration of intrathecal methotrexate. A routine CSF analysis revealed bone marrow contamination, traced to the unintentional sampling of a vertebral body during a lumbar puncture.<br /><br />The specified cells for detailed examination include:<br />- **Orthochromic Normoblasts** (Image ABM-01): Nucleated red blood cells indicative of bone marrow contamination.<br />- **Myeloblasts** (Image ABM-02): Immature granulocytic cells.<br />- **Metamyelocytes** (Image ABM-03): A maturation stage of myeloid cells before band neutrophils.<br />- **Band Neutrophils** (Image ABM-04): Characterized by a C or U-shaped nucleus with abundant secondary granules.<br />- **Segmented Neutrophils** (Image ABM-05): The most mature granulocytes with a multilobated nucleus.<br /><br />The bone marrow consists of adipose and hematopoietic stem cells (HSCs), which differentiate into myeloid lineages such as granulocytes and erythrocytes. The identification of multiple cell lineages in different maturation stages within CSF is crucial for diagnosing bone marrow contamination, distinguishing it from conditions like leptomeningeal spread of malignancies.<br /><br />This commentary aims to improve clinical skills in analyzing CSF specimens, emphasizing the differentiation between normal and contamination-related cellularity, and the potential impact on patient management.

Keywords

bone marrow contamination

cerebrospinal fluid

myeloid cell maturation

Dr. Padmini A. Manrai

American Proficiency Institute

American Society for Clinical Pathology

orthchromic normoblasts

myeloblasts

metamyelocytes

band neutrophils