Guided example: a bounded adequacy statement

An adult marrow was collected for unexplained pancytopenia. The first pull produced five to six spicules, six wedge smears, and two particle-crush preparations prepared at bedside and stained Wright-Giemsa. A separate sodium-heparin aliquot went to flow cytometry and cytogenetics, and an EDTA aliquot went to molecular studies. The core was a single intact 1.8 cm specimen with multiple evaluable intertrabecular spaces and minimal crush artifact.

On the core, representative marrow away from subcortical bone was estimated at 45% cellularity with trilineage hematopoiesis. The aspirate differential counted 500 nucleated cells across two well-prepared smears, selecting the crush preparation rather than the dilute trail. Myeloid cells were 52% and erythroid cells were 22%, so the myeloid-to-erythroid (M:E) ratio, the myeloid percentage divided by the erythroid percentage, is 52 divided by 22, or about 2.4 to 1.

Blasts were 2% of nucleated cells. On core survey, megakaryocyte lobulation assesses nuclear maturation and clustering assesses spatial distribution; neither observation alone supplies a diagnosis. A Perls stain, an iron stain that colors ferric storage iron blue, was read only after its positive control demonstrated expected staining. Storage iron was present and scattered sideroblasts, erythroid precursors with iron granules in their cytoplasm, were seen; no cell met the recognition definition of five or more perinuclear granules around at least one-third of the nucleus. Control performance validates stain performance, not a disease threshold.