Which of the following conditions would warrant a bone marrow aspiration?
a. Iron deficiency in a patient with colon cancer
b. Severe hereditary spherocytosis
c. Disseminated intravascular coagulation (DIC) with very low hemoglobin and marked red cell fragments
d. Not possible to determine obvious reason for anemia
ANS: D
When a patient is anemic and testing reveals no obvious reason, a bone marrow aspiration (smear) is warranted. The myeloid-to-erythroid (M:E) M:E ratio and overall cellularity of the marrow can be assessed. The morphology not only of erythroid but also of all other blood-forming cells in the marrow can be evaluated. This can provide useful information as to the cause. All the other situations listed can be diagnosed with appropriate testing on blood (may include other tests besides hematologic).
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