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Encyclopedia > Bone marrow examination

Bone marrow examination refers to the pathologic analysis of samples of bone marrow obtained by bone marrow biopsy (often called a trephine biopsy) and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, anemia, and pancytopenia. The bone marrow produces the cellular elements of the blood, including platelets, red blood cells and white blood cells. While much information can be gleaned by testing the blood itself (drawn from a vein by phlebotomy), it is sometimes necessary to examine the source of the blood cells in the bone marrow to obtain more information on hematopoiesis; this is the role of bone marrow aspiration and biopsy. A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... For the Dir en grey album, see The Marrow of a Bone. ... A trephine () is a surgical instrument. ... Leukemia or leukaemia (Greek leukos λευκός, white; aima αίμα, blood) is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes). ... Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahlers disease after Otto Kahler) is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. ... This article discusses the medical condition. ... Pancytopenia is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets. ... For other uses, see Blood (disambiguation). ... A 250 ml bag of newly collected platelets. ... “Red cell” redirects here. ... White Blood Cells redirects here. ... Bloodletting (or blood-letting, in modern medicine referred to as phlebotomy) was a popular medical practice from antiquity up to the late 19th century, involving the withdrawal of often considerable quantities of blood from a patient in the belief that this would cure or prevent illness and disease. ... Haematopoiesis is the formation of blood cellular components. ...

A Wright's stained bone marrow aspirate smear from a patient with leukemia.
A Wright's stained bone marrow aspirate smear from a patient with leukemia.

Contents

Image File history File links Acute_leukemia-ALL.jpg‎ A Wrights stained bone marrow aspirate smear of patient with precursor B-cell acute lymphoblastic leukemia. ... Image File history File links Acute_leukemia-ALL.jpg‎ A Wrights stained bone marrow aspirate smear of patient with precursor B-cell acute lymphoblastic leukemia. ... Wrights stain is a technique in histology that is used to make the differences between cells visible under light microscopy. ...

Components of the procedure

Bone marrow samples can be obtained by aspiration and trephine biopsy. Sometimes, a bone marrow examination will include both an aspirate and a biopsy. The aspirate yields semi-liquid bone marrow, which can be examined by a pathologist under a light microscope as well as analyzed by flow cytometry, chromosome analysis, or polymerase chain reaction (PCR). Frequently, a trephine biopsy is also obtained, which yields a narrow, cylindrically shaped solid piece of bone marrow, 2mm wide and 2cm long, which is examined microscopically (sometimes with the aid of immunohistochemistry) for cellularity and infiltrative processes. To meet Wikipedias quality standards, this article or section may require cleanup. ... 1852 microscope Compound microscope made by John Cuff in 1750 A microscope (Greek: micron = small and scopos = aim) is an instrument for viewing objects that are too small to be seen by the naked or unaided eye. ... Analysis of a marine sample of photosynthetic picoplankton by flow cytometry showing three different populations (Prochlorococcus, Synechococcus and picoeukaryotes) Flow cytometry is a technique for counting, examining and sorting microscopic particles suspended in a stream of fluid. ... A metaphase cell positive for the bcr/abl rearrangement using FISH Cytogenetics is the study of the structure of chromosome material. ... “PCR” redirects here. ... Immunohistochemistry or IHC refers to the process of localizing proteins in cells of a tissue section exploiting the principle of antibodies binding specifically to antigens in biological tissues. ...

Comparison
Aspiration Biopsy
Advantages
  • Gives cell and stroma constitution
  • Represents all cells
  • Explains cause of "dry tap" (aspiration gives no blood cells)
Drawbacks Doesn't represent all cells Slow processing

Aspiration doesn't always represent all cells since e.g. lymphoma stick to the trabecula, and would thus be missed by a simple aspiration. Molecular genetics is the field of biology which studies the structure and function of genes at a molecular level. ... Analysis of a marine sample of photosynthetic picoplankton by flow cytometry showing three different populations (Prochlorococcus, Synechococcus and picoeukaryotes) Flow cytometry is a technique for counting, examining and sorting microscopic particles suspended in a stream of fluid. ... This article is about lymphoma in humans. ... Cancellous bone (or trabecular bone, or spongy bone) is a spongy type of bone with a very high surface area, found at the ends of long bones. ...


Site of procedure

Bone marrow aspiration and trephine biopsy are usually performed on the back of the hipbone, or posterior iliac crest. However, an aspirate can also be obtained from the sternum (breastbone). A trephine biopsy should never be performed on the sternum, however, due to the risk of injury to blood vessels, lungs or the heart. Human male pelvis, viewed from front Human female pelvis, viewed from front The pelvis is the bony structure located at the base of the spine (properly known as the caudal end). ... The sternum (from Greek στέρνον, sternon, chest) or breastbone is a long, flat bone located in the center of the thorax (chest). ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... For the village in Tibet, see Lung, Tibet. ... The heart and lungs, from an older edition of Grays Anatomy. ...


How the test is performed

A needle used for bone marrow aspiration, with removable stylet.
A needle used for bone marrow aspiration, with removable stylet.

A bone marrow biopsy may be done in a health care provider's office or in a hospital. Informed consent for the procedure is typically required. The patient is asked to lie on his or her abdomen (prone position) or on his/her side (lateral decubitus position). The skin is cleansed, and a local anesthetic such as lidocaine is injected to numb the area. Patients may also be pretreated with analgesics and/or anti-anxiety medications, although this is not a routine practice. Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. ... Prone refers to the perceived likelihood of being affected by something. ... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... Lidocaine (INN) (IPA: ) or lignocaine (former BAN) (IPA: ) is a common local anesthetic and antiarrhythmic drug. ... An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... An anxiolytic is a drug prescribed for the treatment of symptoms of anxiety. ...


Typically, the aspirate is performed first. An aspirate needle is inserted through the skin until it abuts the bone. Then, with a twisting motion, the needle is advanced through the bony cortex (the hard outer layer of the bone) and into the marrow cavity. Once the needle is in the marrow cavity, a syringe is attached and used to aspirate ("suck out") liquid bone marrow. A twisting motion is performed during the aspiration to avoid a too high content of blood in the sample, which might be the case if a too large sample from one single point is taken. This article is about the skeletal organs. ... Cortical bone, also known as compact bone is one of two main types of osseous tissues. ...


Subsequently, the biopsy is performed if indicated. A different, larger trephine needle is inserted and anchored in the bony cortex. The needle is then advanced with a twisting motion and rotated to obtain a solid piece of bone marrow. This piece is then removed along with the needle. The entire procedure, once preparation is complete, typically takes 10-15 minutes. A trephine () is a surgical instrument. ...


If several samples are taken, the needle is removed between the samples to avoid blood coagulation.


After the procedure

After the procedure is complete, the patient is typically asked to lie flat for 5-10 minutes to provide pressure over the procedure site. After that, assuming there is no bleeding seen, the patient can get up and go about their normal activities. Paracetamol (acetaminophen) or other simple analgesics can be used to ease soreness, which is common for 2-3 days after the procedure. Any worsening pain, redness, fever, bleeding or swelling may suggest a complication. Paracetamol (INN) (IPA: ) or acetaminophen (USAN), is the active metabolite of phenacetin, a so-called coal tar analgesic. ...


Contraindications

There are few contraindications to bone marrow examination. The only absolute reason to avoid performing a bone marrow examination is the presence of a severe bleeding disorder which may lead to serious bleeding after the procedure. If there is a skin or soft tissue infection over the hip, a different site should be chosen for bone marrow examination. Bone marrow aspiration and biopsy can be safely performed even in the setting of extreme thrombocytopenia (low platelet count). In medicine, a contraindication is a condition or factor that increases the risk involved in using a particular drug, carrying out a medical procedure or engaging in a particular activity. ... Thrombocytopenia (or -paenia, or thrombopenia in short) is the presence of relatively few platelets in blood. ... A 250 ml bag of newly collected platelets. ...


Complications

While mild soreness lasting 12-24 hours is common after a bone marrow examination, serious complications are extremely rare. In a large review, an estimated 55,000 bone marrow examinations were performed, with 26 serious adverse events (0.05%), including one fatality.[1] The same author collected data on over 19,000 bone marrow examinations performed in the United Kingdom in 2003, and found 16 adverse events (0.08% of total procedures), the most common of which was bleeding. In this report, complications, while rare, were serious in individual cases.[2] Complication, in medicine, is a unfavorable evolution of a disease, a health condition or a medical treatment. ... This page meets Wikipedias criteria for speedy deletion. ... An adverse event is any change in health that occurs in a person after he or she enrolls in a clinical trial. ...


References

  1. ^ Bain BJ (2003). "Bone marrow biopsy morbidity and mortality". Br. J. Haematol. 121 (6): 949-51. PMID 12786808. 
  2. ^ Bain BJ (2005). "Bone marrow biopsy morbidity: review of 2003". J. Clin. Pathol. 58 (4): 406-8. doi:10.1136/jcp.2004.022178. PMID 15790706. 

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links


  Results from FactBites:
 
MDS FOUNDATION (4799 words)
The bone marrow is examined for 1) the percentages of blasts and abnormal, mature blood cells, 2) iron content of the red blood cells, and 3) abnormalities the chromosomes (cytogenetic findings), such as as missing or extra chromo-somes.
Bone marrow transplantation is potentially a very effective treatment, possibly even a cure, however it is also very risky and requires donation of matched marrow.
To match, the marrow must be donated by a sibling (or, on a very rare occasion by a matched unrelated donor) and must be of the same transplantation type; matching of transplantation type, which is determined through a blood test, should not be confused with matching of blood type.
Bone marrow sampling American Family Physician - Find Articles (816 words)
Bone marrow sampling (aspiration or biopsy) is the process of obtaining and preparing the marrow sample for appropriate laboratory examination.
Bone marrow sampling is useful or necessary in the evaluation of a number of disease processes (Table 1).
To exert enough force to penetrate the cortical bone, the aspiration needle is held with the top of the needle against the pad of the thumb or against the pad at the base of the metacarpophalangeal joint of the index finger.
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