Reevaluation of reference values for bone marrow differential counts in 236 healthy bone marrow donors
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ORIGINAL ARTICLE
Reevaluation of reference values for bone marrow differential counts in 236 healthy bone marrow donors Stefani Parmentier 1 & Michael Kramer 2 & Swetlana Weller 2 & Ulrich Schuler 2 & Rainer Ordemann 2 & Gabi Rall 3 & Markus Schaich 1 & Martin Bornhäuser 2 & Gerhard Ehninger 2 & Frank Kroschinsky 2 Received: 3 July 2020 / Accepted: 1 September 2020 # The Author(s) 2020
Abstract Despite the increasing role of molecular markers, differential counts and morphology of hematopoietic cells in the bone marrow (BM) remain essential diagnostic criteria in hematological diseases. However, the respective reference values for BM myelogram commonly used came from small series with limited numbers of healthy individuals. We evaluated the myelograms of 236 healthy individuals who underwent unrelated bone marrow donation. Health check-ups were performed 4 weeks prior to harvest. Samples for this study, taken from the first aspiration, were stained according to the standard Pappenheim method. Three experienced investigators assessed cellularity, megakaryopoiesis, and differential counts independently. The median donor age was 31 (range 18–51) years. Predonation tests did not reveal any relevant morbidity. Thirty-seven out of 42 hypocellular marrow samples were from younger donors up to 39 years. Content of megakaryocytes was normal in 210 specimens (89%). Gender and body mass index had significant impact on hematopoiesis, whereas age had not. The number of erythroblasts was higher (about 32%) and the proportion granulopoiesis slightly lower (about 50%) compared with previous studies. Differential counts showed also some differences with respect to individual maturation stages in these lines. Interrater comparisons showed greater reliability for the assignment of cells to the different hematopoietic cell lines than for single-cell diagnoses. This study largely confirms the results for cell counts in normal human bone marrow available from previous reports and provides some insights into factors that affect individual cell populations. It also reveals substantial variability among even experienced investigators in cytological diagnoses. Keywords Bone marrow . Cytology . Hematopoiesis . Normal differential counts
Introduction In 1944, E. E. Osgood and A. J. Seaman described a differential count of bone marrow (BM) aspirates from 12 healthy men, which since then has been cited as a reference in Wintrobe’s Clinical Hematology [1, 2]. Fifty-seven years later, Barbara Bain assessed the percentage of cells in freshly obtained, non-anticoagulated bone marrow smears of 50 healthy subjects [3]. The cohort included 30 men and 20 * Frank Kroschinsky [email protected] 1
Department of Hematology, Oncology and Palliative Care, Rems-Murr-Hospital, Winnenden, Germany
2
Medical Department I, University Hospital Dresden, Fetscherstr. 74, 01307 Dresden, Germany
3
DKMS German Bone Marrow Donor Center, Tübingen, Germany
women, aged between 21 and 56 years, who were in good health and free of current infection and allergi
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