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A Comparative Study of Bone Marrow Squash and Wedge Aspiration Smears

Indian Journal of Hematology and Blood Transfusion volume 37, pages 108–118 (2021)Cite this article

Abstract

Bone marrow examination entails study of aspirate smears, touch imprints and trephine biopsy. Bone marrow aspirate smears can be prepared by the squash (crush) or wedge method. Both techniques have their own advantages and disadvantages. There is paucity of studies that have compared these smear types. This study was conducted over a period of one year. Two hundred and five bone marrow aspirates were included. Both squash and wedge smears were made. Blinded slide review was done. Bone marrow cellularity, megakaryocyte number, myeloid to erythroid (M:E) ratio, morphology and final diagnosis on each smear type was compared. Chi square test, t-test and Kappa were applied to study the agreement between the wedge and squash smears. Among the 205 patients studied, squash smears showed significant over estimation of cellularity and megakaryocyte number (p < 0.05). There was no significant difference (p > 0.05) in the M:E ratio and morphological scores. Most patients (188/205 [91.7%]) showed complete diagnostic concordance while 17 (8.3%) patients had discrepancy in diagnosis between the squash and wedge smears. In 8 (3.9%) of these, major discrepancies were seen while 9 (4.4%) patients had minor discrepancies. Bone marrow cellularity and megakaryocyte numbers were underestimated in wedge smears with no differences in M:E ratio or morphology. Acceptable agreement for diagnosis was seen for patients with most disorders. Major diagnostic discrepancies were seen in patients with lesions known to have focal distribution—lymphoma, myeloma and tuberculosis (granulomas). Both squash and wedge smears should be studied for bone marrow examination.

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Acknowledgement

The study was conducted at Christian Medical College & Hospital, Ludhiana. The authors acknowledge the contribution of Mr. Prasan Das, laboratory technician, for retrieval of the bone marrow aspirate slides.

Funding

No funding was required for the study.

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Author notes

  1. Naveen Kakkar

    Present address: Department of Pathology, Maharishi Makandeshwar Medical College & Hospital, Kumarhatti, Solan, Himachal Pradesh, 173229, India

Affiliations

  1. Department of Pathology, Christian Medical College & Hospital, Ludhiana, Punjab, 141008, India

    Neeti Arora Ahluwalia, Naveen Kakkar & Kanwardeep Singh Kwatra

Authors
  1. Neeti Arora Ahluwalia
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  2. Naveen Kakkar
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  3. Kanwardeep Singh Kwatra
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Correspondence to Naveen Kakkar.

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Consent was taken from all patients.

Ethical Approval

This study was a thesis for the post-graduation in pathology by the first author. Ethical and research committee approval was obtained prior to the study.

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No animals were used in this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ahluwalia, N.A., Kakkar, N. & Kwatra, K.S. A Comparative Study of Bone Marrow Squash and Wedge Aspiration Smears. Indian J Hematol Blood Transfus 37, 108–118 (2021). https://doi.org/10.1007/s12288-020-01321-9

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  • DOI: https://doi.org/10.1007/s12288-020-01321-9

Keywords

  • Aspiration
  • Bone marrow
  • Crush
  • Smears
  • Squash
  • Wedge