Specialist Haematology Copy —
Training activity: 12

Details

Identify and annotate the normal morphological features of a bone marrow aspirate and a bone marrow trephine

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Cellular population in bone marrow vs peripheral blood
• Bone marrow organisation
• Local reporting guidelines
• Special stains

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What prior knowledge of normal bone marrow cellularity and morphology at different stages of maturation is required?
• What do you anticipate learning about the key features used to identify and differentiate normal haematopoietic cells in aspirate and trephine samples? What is your current ability to recognise and describe these normal features?
• How will you prepare for this activity (e.g., reviewing morphology atlases, discussing with experienced colleagues)?
• What specific cell lineages and maturation stages will you focus on?
• What potential challenges might you encounter in distinguishing different cell types or recognising normal architecture, and how will you approach these?
• How confident do you feel about your current morphological assessment skills?

In action

• As you are examining the slides, what specific cellular features are you focusing on to determine normality? Why are these features important?
• Are there any areas on the slide where you are unsure about the morphology? What are you doing in that moment (e.g., increasing magnification, seeking a second opinion mentally comparing to reference images)
• How are you ensuring accuracy and consistency in your annotation process as you proceed through the slide?
• Are you noticing any artifacts or technical issues with the slide preparation that might impact your interpretation? How are you accounting for these?

On action

• What were the different cell lineages (e.g., myeloid, erythroid, megakaryocytic, lymphoid) that you identified in the normal bone marrow aspirate and trephine samples?
  • What specific morphological features did you observe and annotate for each of these cell types (e.g., nuclear characteristics, cytoplasm, granules)?
  • How did the cellularity and the ratio of different cell lineages appear in the normal samples?
  • What were the key differences in the information that could be obtained from the aspirate versus the trephine biopsy?
• What are the expected proportions of the different cell lineages in a normal bone marrow?
  • What are the key morphological characteristics that distinguish normal haematopoietic cells at different stages of maturation?
  • Why is it important to assess both the aspirate and the trephine biopsy when evaluating bone marrow?
  • What specific information does each provide?
  • What are the limitations of morphological assessment of bone marrow?
• How will this experience improve your ability to recognise normal bone marrow morphology?
  • What resources will you use as references when assessing bone marrow samples in the future?
  • How will a strong understanding of normal morphology aid you in identifying and interpreting abnormal features indicative of haematological disorders?

Beyond action

• Have you had further opportunities to examine and annotate normal bone marrow aspirates and trephines since this training activity?
• Has your ability to recognise normal features improved with practice?
• Have you reviewed your initial annotations and reflect-on-action notes? Are there any features you now identify or interpret differently?
• Can you recall instances where a strong understanding of normal bone marrow morphology helped you to identify subtle pathological changes in subsequent samples?
• Have you discussed normal bone marrow morphology with colleagues or mentors, perhaps comparing your annotations or interpretations?
• Has this training activity strengthened your foundational knowledge of normal haematopoiesis and bone marrow architecture?
• Do you now feel more confident in distinguishing normal cellular components and structures in bone marrow samples? Has this experience improved your ability to appreciate the subtle deviations from normal that are indicative of disease?
• Has the attention to detail required for accurate annotation been beneficial in other aspects of your morphological assessments?
• How will a strong foundation in normal bone marrow morphology be essential for your continued development in the diagnosis of haematological disorders?
• Will your ability to confidently identify normal features enable you to more accurately detect and interpret pathological abnormalities in the future?
• How might this fundamental skill support your potential progression towards becoming a specialist in haematological morphology?

Relevant learning outcomes

#	Outcome
# 3	Outcome Perform a range of laboratory and molecular testing techniques to diagnose and monitor treatment of haematological malignancy in the correct clinical context, including the interpretation and reporting of results.
# 4	Outcome Interpret and comply with national and international guidelines on the diagnosis and management of haematological cancer.
# 7	Outcome Perform quality assurance and control tasks across the range of investigations.