Today our topic of discussion is Bone Marrow Biopsy and Aspiration.
Bone Marrow Biopsy and Aspiration
BONE MARROW BIOPSY AND ASPIRATION
Aspiration is defined as sucking a small amount of tissue in to the needle by applying suction with syringe.. Biopsy is defined cutting and removing a small amount of tissue from an area for examination.
Hone marrow aspiration is a diagnostic procedure performed in blood dyscrasias in which a specimen of bone marrow is taken from the sternum, diac crest posterior superior iliac spine or tibia (children) by means of a hollow thick needle (Fig 28.11).
Purpose
- To diagnose blood dyscrasia, such as aplastic anemia, leukemia, thrombocytopenia, etc
- To diagnose metastatic neoplasm
- To diagnose deficiency states of vit-biz, folic acid, iron. pyridoxine, etc.
- To diagnose toxic states producing bone marrow depression or destruction
- To determine the number, size and shape of red cells. white cells and platelets
- To follow course of disease and patient’s response to treatment.
Indications
Diagnostic: Bone marrow examination is essential for the diagnosis of a plastic, megaloblastic anemia, multiple myeloma, myelofibrosis, myelosclerosis and aleukemic leukemia.
Bone marrow examination is helpful but not essential for diagnosis of anemia, leukemia, thrombocytopenic purpura. agranulocytoma, tropical diseases; malaria, kala-azar, etc.
Prognostic: Agranulocytosis, leukemia and anemia Therapeutic Bone marrow transplant.
Site and Position of the Patient (Fig. 28.12)
Sternal puncture: The usual puncture site is either the manubrium sterni or the upper part of the body of sternum. The patient lies in the dorsal recumbent position (supine) with a pillow under the shoulders to raise the chest.
Iliac puncture: The bone marrow biopsy is taken from the iliac crest 2 cm posterior and 2 cm interior to the anterior superior iliac spine. Alternately, the posterior iliac spine is also used. For iliac puncture, the patient lies either on his side or abdomen.
Spinous process aspiration: In the spinous process of the lumbar vertebrae, usually 13 or L4 is the puncture site. The patient is placed in the lumbar puncture position.
Tibial puncture in children: In children up to the age of two years the proximal end of tibia, just below the tibial condyles and medial to the tibial tuberosity is selected.