Disease: Bone Marrow Aspiration and Biopsy

    What is bone marrow?

    The soft material in the center of bones is the bone marrow. The bone marrow contains the different types of cells that give rise to red cells, white cells and platelets found in our blood. The marrow may also contain abnormal cells, proteins, or inflammatory processed that are not normally present, such as cancer cells. Since the production of red cells requires iron, the marrow is one of the places in the body that normally stores a supply of iron. When we are younger, our bone marrow contains very little fat. As we age, the percentage of fat in our marrow increases.

    What is a bone marrow procedure?

    A bone marrow procedure (commonly referred to as a bone marrow or bone marrow aspiration with or without biopsy) is a technique used to obtain the blood-forming portion (marrow) of the inner core of bone for examination in the laboratory or for transplantation. The bone marrow consists of inserting a special needle into a bone and withdrawing the marrow by suction or coring out a sample of the marrow.

    Why are bone marrows done?

    Most bone marrows are performed to diagnose various conditions that affect the different types of blood cells. Abnormal blood counts can lead a doctor to suspect that there may be a problem in the bone marrow. Another frequent purpose of a bone marrow is to diagnose certain cancers or to determine the extent of the cancer (cancer staging) within the bone marrow. Bone marrow procedures can also detect uncommon conditions, both cancerous and non-cancerous including abnormal proteins (such as in amyloidosis), inflammation (such as in sarcoidosis), and infection (such as in tuberculosis). This procedure can also be used to obtain marrow for transplantation.

    What bone is used to sample the bone marrow?

    The most frequent site for obtaining bone marrow is the pelvic bone, known as the ilium. A portion of this bone is readily accessible in most people from the lower back and is usually marked by shallow dimples on either side of the spine. Other sites include the front of the pelvic bone near the groin and the sternum at the front of the chest.

    How is a bone marrow performed?

    Typically, only a local anesthetic is required to numb the skin and tissue down to the surface of the bone. A small cut (less than one-quarter inch) is then made in the skin. A hollow needle whose center is filled by a removable metal rod called a trochar is used to penetrate through the dense outer shell of bone. Once inside the bone, the trochar is removed and a syringe is attached to the now hollow tube of the bone marrow needle. The bone marrow is withdrawn as a thick liquid by pulling back on the plunger of the syringe and collecting the liquid. This sample is known as the marrow aspirate. This part of the procedure only lasts a few seconds, but is usually the most painful due to the sudden sense of a negative pressure inside the bone.

    A biopsy can also then be obtained in addition to the marrow aspirate or when an aspirate cannot be obtained. The same needle is used but without the center portion in place. As the needle is partially rotated into the bone it cuts a core which is trapped inside the needle. Once the needle is removed, this core can be extracted from the needle barrel. This core can then be prepared with fixatives and stains for examination under a microscope.

    Since the skin cut for a bone marrow procedure is usually very small, no stitches are generally necessary and only a bandage is applied.

    What is done with the bone marrow sample?

    The bone marrow core biopsy is first placed in a liquid that keeps the cells in their natural condition (fixative solution). The sample is then placed in a solution to soften the bone and is finally processed like other biopsies in the tissue study (histology) laboratory. The liquid portion of the bone marrow is spread on glass slides and stained to make the bone marrow smears. The slides are then examined under the microscope, usually by a specially qualified technician or physician such as a hematologist or pathologist.

    Portions of either sample may be submitted to the microbiology laboratory for cultures. Certain conditions may require other specialized studies such as genetic testing or cell marker studies.

    How is a bone marrow performed?

    Typically, only a local anesthetic is required to numb the skin and tissue down to the surface of the bone. A small cut (less than one-quarter inch) is then made in the skin. A hollow needle whose center is filled by a removable metal rod called a trochar is used to penetrate through the dense outer shell of bone. Once inside the bone, the trochar is removed and a syringe is attached to the now hollow tube of the bone marrow needle. The bone marrow is withdrawn as a thick liquid by pulling back on the plunger of the syringe and collecting the liquid. This sample is known as the marrow aspirate. This part of the procedure only lasts a few seconds, but is usually the most painful due to the sudden sense of a negative pressure inside the bone.

    A biopsy can also then be obtained in addition to the marrow aspirate or when an aspirate cannot be obtained. The same needle is used but without the center portion in place. As the needle is partially rotated into the bone it cuts a core which is trapped inside the needle. Once the needle is removed, this core can be extracted from the needle barrel. This core can then be prepared with fixatives and stains for examination under a microscope.

    Since the skin cut for a bone marrow procedure is usually very small, no stitches are generally necessary and only a bandage is applied.

    What is done with the bone marrow sample?

    The bone marrow core biopsy is first placed in a liquid that keeps the cells in their natural condition (fixative solution). The sample is then placed in a solution to soften the bone and is finally processed like other biopsies in the tissue study (histology) laboratory. The liquid portion of the bone marrow is spread on glass slides and stained to make the bone marrow smears. The slides are then examined under the microscope, usually by a specially qualified technician or physician such as a hematologist or pathologist.

    Portions of either sample may be submitted to the microbiology laboratory for cultures. Certain conditions may require other specialized studies such as genetic testing or cell marker studies.

    Source: http://www.rxlist.com

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