Bone marrow examination

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Bone marrow examination refers to the pathological analysis of bone marrow samples obtained with bone marrow biopsy (often called trephine biopsy) and spinal cord aspiration . Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia. Bone marrow produces blood cell elements, including platelets, red blood cells and white blood cells. While much information can be collected by testing the blood itself (taken from the vein by phlebotomy), it is sometimes necessary to examine the source of blood cells in the bone marrow for more information on hematopoiesis; this is the role of bone marrow aspiration and biopsy.

Video Bone marrow examination

Komponen prosedur

Bone marrow samples can be obtained by aspiration and trephine biopsy. Occasionally, bone marrow examination will include aspiration and biopsy. Aspiration produces a semi-liquid bone marrow, which can be examined by a pathologist under a light microscope and analyzed with flow cytometry, chromosome analysis, or polymerase chain reaction (PCR). Often, trephine biopsies are also obtained, which produce intact cylindrical bone intact pieces, 2mm wide and 2 cm long (80 μL), microscopically examined (sometimes with immunohistochemical aid) for cellular and infiltrative. process. Aspiration, using 20 mL syringe, produces about 300 L of bone marrow. Volume greater than 300? L is not recommended, as it may dilute the sample with peripheral blood.

Aspiration does not necessarily represent all cells because some such lymphoma attaches to the trabeculae, and thus will be missed by simple aspirations.

Maps Bone marrow examination

Site procedure

Bone marrow aspiration and trephine biopsy are usually performed behind the hip bone, or posterior iliac crest. An can also be obtained from the sternum (breastbone). For sternal aspiration, the patient lies on his back, with a pillow under his shoulders to raise the chest. A trephine biopsy should not be performed on the sternum, because of the risk of injury to blood vessels, lungs or heart. Bone marrow aspiration may also be performed on the tibial site (tibial) in children up to the age of 2 years, while aspiration of the spinous process is often performed on the lumbar puncture position and on the L3-L4 vertebra.

Anesthesia is used to reduce pain in the place where the needle is inserted. Pain can be caused by disgruntled procedures on the marrow, which can not be anesthetized, as well as brief periods of pain from the anesthesia process itself. His experience is not uniform; Different patients report different levels of pain, and some do not report pain at specific points expected.

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How the test was done

Bone marrow biopsy may be performed at a health care provider's office or in a hospital. Informed consent for procedures is usually required. The patient is asked to lie on the abdomen (prone position) or on the side (lateral decubitus position). The skin is cleansed, and local anesthesia such as lidocaine or procaine is injected to kill the area. Patients can also be treated with analgesic and/or anti-anxiety medications, although this is not a routine practice.

Usually, aspiration is done first. An aspirate needle is inserted through the skin using manual pressure and strength to the border. Then, with the twisting movements of the doctor's hand and wrist, the needle is passed through the bone cortex (the outer layer of the hard bone) and into the marrow cavity. Once the needle is in the marrow cavity, the syringe is installed and used for aspiration ("suck") of the bone marrow. Rotating motion is done during aspiration to avoid excess blood levels in the sample, which may be the case if too large samples from a single point are taken. Furthermore, a biopsy is performed if indicated. Larger and larger trephine needles are inserted and anchored in the bone cortex. The needle then proceeds in a circular motion and is rotated to get a solid spine piece. The piece is then removed along with the needle. The whole procedure, after preparation is complete, usually takes 10-15 minutes.

If multiple samples are taken, a needle is removed between the samples to avoid blood clotting.

After the procedure is complete, the patient is usually asked to lie down for 5-10 minutes to apply pressure above the procedure site. After that, assuming no bleeding was observed, patients could wake up and go about their normal activities. Paracetamol (aka acetaminophen) or other simple analgesics may be used to relieve pain, which is common for 2-3 days after the procedure. Pain, redness, fever, bleeding, or worsening swelling can show complications. Patients are also advised to avoid washing the procedure site at least 24 hours after the procedure is completed.

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Contraindications

There are several contraindications to bone marrow examination. It is important to note that thrombocytopenia or bleeding disorders are not contraindicated during the procedure performed by an expert physician. Bone marrow aspiration and biopsy can be performed safely even in the setting of extreme thrombocytopenia (low platelet count). If there is a skin or soft tissue infection in the hip, different sites should be selected for bone marrow examination.

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Complications

While mild pain lasting 12-24 hours is common after bone marrow examination, serious complications are very rare. In a large review, an estimated 55,000 bone marrow examinations were performed, with 26 serious adverse events (0.05%), including one death. The same authors collected data on more than 19,000 bone marrow examinations performed in the UK in 2003, and found 16 adverse events (0.08% of total procedures), the most common being bleeding. In this report, complications, though rare, are serious in individual cases.

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References

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External links

• Picture Guides for Aspiration of Bone Marrow and Biopsy
• MedlinePlus: Bone marrow biopsy
• eMedicine: Bone Marrow and Biopsy Aspiration
• Bone Marrow Smear preparation (video) by Craig E. Litz, M.D.
• Vidacare OnControl Bone Marrow Biopsy and Aspiration System

Source of the article : Wikipedia