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Bone marrow biopsy is the basic test that is performed to diagnose diseases of the hematopoietic system. There are two types of bone marrow biopsy - fine needle aspiration and percutaneous trepanobiopsy. What are these two methods of bone marrow biopsy? What are the indications for their implementation? How to interpret the test results?

Bone marrow biopsyis an invasivetestwhich involves taking a sample of hematopoietic pulp (marrow) from the bone marrow cavity with a special needle with a syringe ( fine needle aspiration biopsy ) or a small bone fragment containing marrow ( percutaneous trepanobiopsy ).

Bone marrow biopsy - indications

Fine-needle bone marrow aspiration is performed on patients suspected of:

  • leukemias - acute myeloid and acute lymphoblastic
  • monoclonal gammapathies (including multiple myeloma, Waldenstrom's macroglobulinemia)
  • Hodgkin's and non-Hodgkin's lymphomas
  • myeloproliferative neoplasms
  • anemia (iron deficiency, vitamin B12 deficiency and folic acid, thyroid cell, haemolytic anemia of intra- and extra-cellular etiology)
  • white blood cell count disorders (neutrophilia, eosinophilia, basophilia, lymphocytosis and lymphopenia, monocytosis, neutropenia)
  • myelodysplastic syndromes
  • thrombocytopenia
  • thrombocythemia
  • toxic bone marrow damage
  • suspected bone marrow metastasis
  • diseases associated with the deposition of monoclonal immunoglobulins (e.g. amyloidosis)

A bone marrow biopsy can be performed when the diagnosis cannot be clearly confirmed by peripheral blood and coagulation tests or other tests. In addition, aspiration biopsy is performed in patients treated for the above-mentioned. disease to assess its course.

Percutaneous trepanobiopsy is performed when the material cannot be collected by aspiration biopsy.

Bone marrow biopsy - what is it?

Stages of fine needle aspiration bone marrow biopsy:

1. The patient is laid down on his back or on his stomach (depending on the place from which the marrow will be collected) 2. The skin is decontaminated and injectedlocal anesthesia. In children, bone marrow biopsy is performed under general anesthesia3. After a few minutes, the doctor inserts a special biopsy needle into the medullary cavity (in adults, the bone marrow is usually taken from the crest of the iliac plate or sternum, and in children, the tibia and lumbar vertebrae bodies). The needle has a stop to prevent it from being guided too deep into the medullary canal. Then the doctor attaches a syringe to the inserted needle. Then, by retracting the syringe plunger, which creates a vacuum in it, the medullary pulp is withdrawn. This moment is painful, but it only lasts for a while4. After the bone marrow is collected, a pressure dressing is introduced at the puncture site with the needle. If necessary, a surgical suture is placed at the point of needle insertion5. The needle is detached from the syringe containing the contents of the medullary pulp. Then the so-called smears, i.e. the marrow pulp, are spread on microscope slides, and then stained with special dyes and examined under a microscope

Percutaneous trepanobiopsy is similar to fine-needle aspiration biopsy, but the needle is inserted deeper, about 3-4 cm. In addition, trepanobiopsy is performed only from the hip bone. After the needle has been inserted, several swinging movements are made to the sides to cut off the bone fragment with the marrow. The needle is then slowly pulled out, and then the removed bone fragment is pushed out onto a sterile gauze pad.

Bone marrow biopsy - complications

After the examination, there may be bleeding or a hematoma at the needle puncture site.

Bone marrow biopsy - test results

After donating the bone marrow for laboratory testing, thebone marrow myelogram is performed , which is an assessment of the percentage of individual bone marrow cells. In addition, atypical bone marrow cells and cancer cells from outside the bone marrow are searched for.

For example, a decrease in red blood cells, without an increase in reticulocytes, may suggest aplastic anemia. In turn, in the case of acute lymphoblastic leukemia, the material collected during the biopsy shows the presence of over 25%. lymphoblasts (these cells give rise to leukemia), which displace the normal elements of the bone marrow.

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