Depending on the laboratory protocols and the hematopathologist's preference, the technologist's responsibilities in bone marrow aspirate processing and reviewing can vary from simply staining slides to complex tasks such as smearing, staining, counting, and distributing samples based on laboratory standard protocols.
While laboratory professionals may perform bone marrow differentials, it is the hematopathologist's responsibility to review, interpret, and verify those counts after evaluating all of the samples that were provided. This includes both the bone marrow aspirate and biopsy smears, as well as the flow cytometry data if required.
When differentiating and counting samples with increased numbers of blasts, the technologist may make a determination of cell line for the blasts, according to observations on a Wright or Wright-Giemsa stained slide, but the hematopathologist may modify this placement based on flow cytometry data and additional special stains.
The laboratory technologist can assess cellularity, the presence of megakaryocytes, and the possible presence of tumor cells on the bone marrow smears. Ultimately, the hematopathologist is responsible for interpreting the bone marrow differential results after a meticulous review of all smears stained, as well as any biopsy sections available. It is also the hematopathologist's responsibility to identify tumor cells that may be present.
In laboratories that use a standard order set with sample drop off directly from the bedside, it is the technologist's responsibility to split and distribute the marrow based on laboratory protocol. It is the hematopathologist's responsibility to verify that standard order testing was actually sent and to add on any additional testing deemed necessary, based on the clinical history and lab findings.
Once you become comfortable with bone marrow morphology and more familiar with your laboratory's protocols, performing marrow differentials will become less intimidating and more of a collaboration between technologist and hematopathologist.
