Bone Marrow Aspiration And Biopsy

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Definition

Bone marrow aspiration and biopsy are two procedures performed to obtain a sample of bone marrow for diagnostic purposes. Both procedures involve the removal of a small amount of bone marrow from the hipbone or breastbone.

Indications 

Both bone marrow aspiration and biopsy are important diagnostic tools in the evaluation of various medical conditions such as blood cancers, anemia, infections, and other blood disorders. The results of these procedures help to determine the underlying cause of the patient’s symptoms and guide the selection of appropriate treatment options.

Test Principle

Bone marrow aspiration is a procedure in which a needle is inserted through the skin and into the bone marrow cavity to remove a small amount of liquid bone marrow. The procedure takes only a few minutes and is usually done under local anesthesia. The liquid bone marrow is then examined under a microscope to check for abnormalities in the blood cells, such as leukemia, anemia, or other blood disorders.

Bone marrow biopsy, on the other hand, involves the removal of a small piece of bone and bone marrow tissue from the hipbone or breastbone using a special needle. The procedure may cause some discomfort, and local anesthesia or sedation is often used to minimize pain. The bone and bone marrow tissue sample are then examined under a microscope to check for abnormalities in the bone marrow structure and the presence of cancerous or non-cancerous cells.

Sample

Bone Marrow Aspirate – Liquid portion of bone marrow

Biopsy – Sold part plus parts of bone

Test Preparation / Instructions

If you are preparing to undergo a bone marrow aspiration procedure, your healthcare provider will provide you with specific instructions to follow before the procedure. Here are some general instructions that may apply:

  • Fasting: You may be instructed to avoid eating or drinking anything for several hours before the procedure. This is usually required if you are undergoing sedation or anesthesia.
  • Medications: Inform your healthcare provider about any medications you are currently taking, including prescription and over-the-counter medications, vitamins, and supplements. You may be asked to stop taking certain medications, such as blood-thinning agents, for a few days before the procedure.
  • Clothing: Wear comfortable clothing that is easy to remove and allows access to the area where the procedure will be performed. You may be given a gown to wear during the procedure.
  • Arrangements: Arrange for someone to drive you home after the procedure, especially if you will be given sedation or anesthesia.
  • Consent: You will be asked to sign a consent form that explains the risks and benefits of the procedure and provides permission for the procedure to be performed.
  • Questions: If you have any questions or concerns about the procedure, don’t hesitate to ask your healthcare provider or the staff performing the procedure.

Following these instructions can help ensure a successful bone marrow aspiration procedure and minimize any discomfort or complications.

Test Procedure

Bone marrow aspiration
Courtesy: Medlineplus
  1. The patient is positioned either lying on their back or on their side, depending on the location of the bone marrow to be aspirated.
  2. The skin over the site where the bone marrow aspiration will take place is cleaned with an antiseptic solution.
  3. A local anesthetic is administered to numb the area where the bone marrow aspiration needle will be inserted.
  4. Once the area is numb, the doctor or nurse inserts a special needle into the bone. This needle is typically inserted into the pelvic bone, although it can also be inserted into the breastbone or other bones.
  5. Once the needle is inserted, the doctor or nurse draws out a small amount of liquid bone marrow. This is done by attaching a syringe to the needle and pulling back on the plunger.
  6. The needle is then removed, and the sample of bone marrow is collected in a test tube or other container.
  7. Depending on the reason for the bone marrow aspiration, multiple samples may be collected from different areas of the bone.
  8. After the procedure is complete, the patient may experience some mild pain or discomfort at the site of the aspiration. This can be managed with over-the-counter pain relievers.
  9. The collected bone marrow samples are sent to a laboratory for analysis. Results are typically available within a few days.

Overall, bone marrow aspiration is a safe and relatively quick procedure that can provide important diagnostic information about a range of medical conditions. If you have any concerns or questions about the procedure, it is important to discuss them with your healthcare provider.

Results Interpretation

Here is a general overview of how bone marrow aspirate results are reported and interpreted:

  • Examination of the bone marrow sample: Cytology and histology

The laboratory technician examines the bone marrow sample under a microscope to assess its cellular composition. This examination includes the assessment of the number, size, shape, and appearance of different types of blood cells, including red blood cells, white blood cells, and platelets. The cellular composition of the bone marrow can provide important diagnostic information about a range of medical conditions, including anemia, leukemia, and lymphoma.

  • Cytogenetic analysis: 

In addition to examining the cellular composition of the bone marrow sample, the laboratory technician may perform cytogenetic analysis. This involves the examination of the chromosomes within the bone marrow cells for any abnormalities. Cytogenetic analysis can be used to diagnose certain types of cancer, such as leukemia, and to guide treatment decisions.

  • Flow cytometry:

 Flow cytometry is a laboratory technique that can be used to identify and quantify different types of cells in a bone marrow sample. This technique is often used to diagnose and monitor blood and bone marrow cancers

  • Immunohistochemistry: 

This technique is used to determine the protein expression in the bone marrow sample and may help to diagnose certain types of blood and bone marrow cancers.

  • Molecular testing:

 In some cases, molecular testing may be performed on the bone marrow sample. This involves the examination of the genetic material within the bone marrow cells for any mutations or abnormalities. Molecular testing can provide important diagnostic and prognostic information and can guide treatment decisions.

Reporting and interpretation: 

The laboratory technician prepares a report summarizing the findings of the bone marrow aspirate. This report is typically sent to the healthcare provider who ordered the test. The report includes a summary of the cellular composition of the bone marrow, any cytogenetic or molecular abnormalities identified, and an interpretation of the findings.

The interpretation of bone marrow aspirate results is complex and requires the expertise of a hematologist or oncologist. The healthcare provider will review the results of the bone marrow aspirate in the context of the patient’s medical history, physical examination, and other diagnostic tests to make a diagnosis and develop a treatment plan.

Follow-up Testing

After a bone marrow aspiration, follow-up testing may be ordered to further evaluate the results and provide additional diagnostic or prognostic information. The specific follow-up testing ordered will depend on the reason for the bone marrow aspiration, the results of the initial testing, and the suspected or confirmed diagnosis. Here are some examples of follow-up testing that may be ordered after a bone marrow aspiration:

  • Imaging studies:

Imaging studies such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, or positron emission tomography (PET) scans may be ordered to evaluate the extent of disease and to guide treatment decisions.

  • Blood tests: 

Blood tests such as complete blood count (CBC), blood chemistry panel, and tumor markers may be ordered to provide additional diagnostic or prognostic information.
The specific follow-up testing ordered will depend on the individual case, and the healthcare provider will determine the appropriate tests based on the patient’s unique medical history and circumstances

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