Opening problem: Is this marrow usable?

A marrow aspirate reaches the bench with a request for unexplained pancytopenia. The particle area contains five to six visible spicules, small marrow-particle fragments that indicate particulate aspirate material. Before counting cells, decide whether the preparation represents marrow and whether the available material can answer the requested question.

Hemodilution is blood contamination from surrounding sinusoids and can make a marrow differential look more mature than the marrow particles themselves. An aspirate with no visible marrow particles, megakaryocytes, or hematopoietic precursors should be treated as a blood-tap sample rather than a diagnostic marrow aspirate. Record particulate, aparticulate, hemodilute, or dry tap status because that condition changes the meaning and disposition of the result. CLIA requires written local policy for specimen acceptability and rejection, not a universal numeric marrow threshold.

The case has a particulate aspirate, bedside-prepared smears, and a core that will provide architecture and cellularity. That combination supports a controlled review, but every conclusion still depends on the field selected and the preparation quality. Do not use a dilute trail as a substitute for particle review. Document the specimen condition before interpreting a differential.