What Is Bone Marrow ??
WHAT IS BONE MARROW??
The bone marrow is one of the most widely distributed organs in the human body.
It is the principal site of blood formation beginning at the time of birth, at which time all bone cavities are filled with hematopoietic tissue.
What is BONE MARROW TEST?
Bone marrow examination is useful in the diagnosis and staging of hematologic disease, as well as in the assessment of overall bone marrow cellularity.
Because of easy accessibility, aspiration, biopsy, and culture of the bone marrow may also play a role in the assessment of patients with fever of undetermined origin as well as in the diagnosis of various storage and infiltrative disorders.
Let’s discuss what are the indications, contraindications, technique, and complications of bone marrow aspiration and biopsy.
What are the Indications for bone marrow aspiration and biopsy?
- Unexplained anemia
- Macrocytic anemia (to distinguish megaloblastic from normoblastic maturation)
- Unexplained leukopenia
- Unexplained thrombocytopenia
- Pancytopenia
- Presence of blasts on peripheral smear (investigation for possible leukemia)
- Presence of teardrop red cells on peripheral smear (possible myelofibrosis)
- Presence of hairy cells on peripheral smear (possible hairy cell leukemia)
- Suspected multiple myeloma
- Staging of non-Hodgkin's lymphoma
- Unexplained splenomegaly (possible lymphoma)
- Suspected storage disease (eg, Gaucher disease, Niemann-Pick)
- Fever of unknown origin
- Suspected chromosomal disorders in neonates (requiring rapid confirmation)
- Confirmation of normal marrow in potential allogeneic donor
- Work-up of amyloidosis (to detect clonal plasma cell disorder)
What are the contraindications for Bone marrow test ?
- Severe hemophilia
- Severe disseminated intravascular coagulopathy
- Severe bleeding disorders.
- Thrombocytopenia, regardless of severity, is not a contraindication.
How is needed forBone Marrow test?
- Povidone-iodine antiseptic solution for cleansing the chosen site, along with the necessary drapes to maintain sterility at the site.
- A 1 or 2 percent lidocaine solution for local anesthesia, along with a sterile syringe, a 23-gauge and a 21-gauge needle
- A number 11 scalpel blade for making the skin incision prior to inserting the aspiration and biopsy needles
- Sufficient quantities of sterile gauze and bandages to clean the biopsy site and to apply local pressure to insure hemostasis when the procedure has been completed
- A large selection of needles used for aspiration is available.
A needle with a stylet that can be fixed in place initially and removed later is preferred.
It is important to use a sharp needle, as well as one long enough to penetrate through the subcutaneous tissues and into the marrow cavity. - Jamshidi biopsy needle with stylet and a device (obturator) for removing the biopsy core from the needle without damage to the specimen.
This procedure can be easily done on day care basis in OT or in OPD.
Consult your HEMATOLOGIST IN MUMBAI for any queries and he will assure you to make the procedure simple with minimal pain..
What are the sites of BONE MARROW TEST ?
Posterior superior iliac spine is the most common site
- Necessary premedications (anxiolytics or pain medications) is administered
- You are placed in either a prone or lateral decubitus position, with the knees pulled closer to the chest.
- Posterior Superior Iliac Spine and Anterior Superior Iliac spine are palpated
- Your Hematologist will Maintain a steady dialogue with you , explaining each step, alerting you to potential discomfort, with reassurance .
- The chosen area is cleansed with povidone-iodine solution and draped.
- The skin is anesthetised and subcutaneous tissues with a 1 to 2 percent lidocaine solution using a 23-gauge needle.
- Once local anesthesia has been achieved, small (3 mm) skin incision with a scalpel blade is made at the site of insertion of the aspiration needle, in order to facilitate its entry and promote organized healing of the wound.
- The bone marrow needle with stylet is held in place perpendicular to the skin at the previously marked point, and gently advanced to the periosteum.
- The stylet is removed and a 2 mL syringe is attached
- 0.2 to 0.5 mL of marrow contents is aspirated and the syringe Is removed .It may be necessary to attach additional syringes if many studies have been adviced .
- The non-anticoagulated specimen is handed over to the assistant, who will assess the quality of the sample (ie, determine the presence or absence of grossly visible bone spicules) and prepare the various smears. Anticoagulated specimens is sent to the laboratory for further preparation and other tests (eg, cytogenetics, molecular studies, cultures, flow cytometry).
- Once it has been determined that the aspirate is satisfactory, the needle is removed by using a similar twisting motion, and pressure to the site is applied with a small gauze square until the bleeding stops.
Consult Your HEMATOLOGIST IN MUMBAI OR BLOOD DISORDER SPECIALIST IN MUMBAI for any queries on BONE MARROW TESTS