College of American Pathologists
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CAP Today



January 2008
Feature Story

Bone marrow biopsy

My thanks to William Check, PhD, for the revealing article about the evolution of bone marrow sampling (November 2007, page 1). I was unaware that nurses and technicians were now sampling marrows, but I did witness the procedure being done as a convenience by the hospital-based pathologist, then moving to the heme-onc specialist as the billing for the procedure improved.

I would like to recognize Matthew Block, MD, of the University of Colorado School of Medicine, as one of the early and strongest advocates of the (then Westerman-Jensen) biopsy, training both hematology and pathology residents. He emphasized several things: patient comfort—use of adequate periosteal anesthesia around the biopsy site and, thanks to his outstanding morphology of the methacrylate-embedded sections (he published a wonderful book on this morphology), the lack of need for painful aspiration in followup or monitoring procedures. Avoiding biopsy in favor of aspiration, as some encourage in your article, is probably due to morphologic limitations in both preparation and experience in current practice, but backward in Dr. Block’s thinking.

The development of new and disposable needles represents great progress. I appreciate the review of the process in your article.

David A. Mulkey, MD
Quest Diagnostics

Las Vegas

Peripheral smear review guidelines

I just read the question and answer in the December issue about where to find guidelines for peripheral blood smear review (“Q&A,” page 80). I would like CAP TODAY readers to know also that the International Society for Laboratory Hematology has published consensus guidelines on peripheral smear review. The guidelines can be accessed at

Linda M. Sandhaus, MD
Associate Professor of Pathology

University Hospitals

Case Medical Center