The report of the bone marrow films should
include the clinical details, the major features
of the blood count, the results of blood film
examination, and the bone marrow findings. It
is useful to include the white cell count,
haemoglobin concentration, platelet count,
mean cell volume, and reticulocyte count as a
routine, but in selected patients other important
blood count abnormalities should be
recorded. The report should then include
details of the aspiration procedure, specifically
the site of aspiration, whether aspiration was
easy or difficult, and whether or not bone texture
was normal. The report on the bone marrow
films should differentiate factual statements
from opinion. The body of the report
should include an assessment of cellularity and
a systematic description of each lineage. The
myeloid to erythroid cell ratio and the salient
features of the differential count should be
given. The report should include a list of other
investigations that have been performed—for
example, “trephine biopsy and immunophenotyping
to follow”, so that clinical staff are aware
of any investigations that are still pending.
Finally, the report should have a summary or
conclusion in which it is appropriate to express
an opinion and, if necessary suggest further
tests. If it is possible to make a definite diagnosis
this should be done. Varying levels of
certainty might be expressed as follows: (1)
“the findings are those of multiplemyeloma” or
“the diagnosis of multiple myeloma is confirmed”;
(2) “the bone marrow features are
compatible with multiple myeloma but are
insufficient in themselves to establish the diagnosis”
or “the bone marrow findings support a
diagnosis or multiple myeloma but should be
assessed in the light of clinical, radiological,
and other laboratory features”; (3) “the bone
marrow aspirate does not support a diagnosis
of multiple myeloma but results of the trephine
biopsy are still outstanding” or “the bone marrow
aspirate shows no features suggestive of
multiple myeloma”.