ICSH Guidance on Bone Marrow Examination and Reporting

Examination of the bone marrow (BM) remains fundamental to the diagnosis, classification, prognostication, and monitoring of hematolymphoid and other disorders affecting blood cell production. Since publication of the International Council for Standardization in Haematology (ICSH) guideline in 2008, advances in diagnostic technologies, disease classification systems and laboratory reporting practices have significantly evolved. These developments necessitate a framework to support contemporary BM evaluation and reporting. This document, prepared by an international ICSH Working Party, provides updated guidance on the examination and reporting of BM specimens and is an extension and refinement of the 2008 ICSH guidelines. It outlines the appropriate application and integration of key diagnostic modalities, including morphological assessment of BM aspirate and trephine biopsy specimens, immunophenotypic analysis by flow cytometry and immunohistochemistry and molecular genetic testing. Central to this guidance is the principle of integrated reporting, whereby findings from all diagnostic modalities are synthesized within the clinical context and aligned with current international classification systems. The ICSH acknowledges the emergence of automated digital microscopy, computational decision support tools, and other technological innovations in BM analysis. These developments hold considerable promise, but whilst many remain under evaluation, specific guidance regarding their routine clinical implementation is beyond the scope of this document.