‫بسم هللا الرحمن الرحيم‬

Kingdom of Saudi Arabia

Al Baha university
Faculty of medicine
Laboratory medicine module

SDL1

Bone Marrow Examination

Jamman ali alzhrani

433004489

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Why bone marrow examination is performed?
Currently, inspection of bone marrow is considered one of the most
valuable diagnostic tools for evaluating hematologic
disorders. Indications have included diagnosis, staging, and therapeutic
monitoring for lymphoproliferative disorders such as chronic
lymphocytic leukemia CLL), Hodgkin and non-Hodgkin
lymphoma, hairy cell leukemia, myeloproliferative
disorders, myelodysplastic syndrome and multiple myeloma.
Furthermore, evaluation of cytopenia, thrombocytosis, leukocytosis,
anemia, and iron status can be performed. Bone marrow inspection is also
done to rule out inflitrative infectious diseases such as fungal infections,
tuberculosis, and other granulomatoses.

The application of bone marrow analysis has grown to incorporate other,

nonhematologic, conditions. For example, in the investigation for fever of
unknown origin (FUO), specifically in those patients with AIDS, the
marrow may reveal the presence of microorganismsn that can cause
infections such as tuberculosis, Mycobacterium avium-
intracellulare (MAI; also referred to as Mycobacterium avium complex
[MAC]) infections, histoplasmosis, leishmaniasis, and other disseminated
fungal infections.

Bone marrow analysis can also be performed in patients with idiopathic

thrombocytopenic purpura (ITP), incidental elevated serum paraprotein
levels, iron deficiency anemia, polycythemia vera, essential thrombocytosis,
or infectious mononucleosis; but these conditions are often more
appropriately diagnosed by routine laboratory
evaluation. Thrombocytopenia is not in itself a contraindication for bone
marrow aspiration and biopsy.

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Difference between aspiration & biopsy

A bone marrow biopsy removes a small amount of bone and a small

amount of fluid and cells from inside the bone (bone marrow). A bone
marrow aspiration removes only the marrow. These tests are often done
to find the reason for many blood disorders and may be used to find out if
cancer or infection has spread to the bone marrow.

Bone marrow aspiration removes a small amount of bone marrow fluid

and cells through a needle put into a bone. The bone marrow fluid and
cells are checked for problems with any of the blood cells made in the
bone marrow. Cells can be checked for chromosome problems. Cultures
can also be done to look for infection.

A bone marrow biopsy removes bone with the marrow inside to look at
under a microscope. The aspiration (taking fluid) is usually done first,
and then the biopsy.

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Anatomical site in adult & children

The left or right posterior iliac crest is the most commonly used site to
obtain a bone marrow biopsy and aspiration, sternum can be allowed for
aspiration Only but not for biopsy because of vital organ.

In Children:
As the same site in adult.
Contraindication & risk

Hemorrhagic disorders such as congenital coagulation factor deficiencies

(eg, hemophilia), disseminated intravascular coagulation and concomitant
use of anticoagulants.
If a BMA or a BMTB is absolutely indicated in these patients, then factor
replacement or cessation of anticoagu lation should be considered before
the procedure, and the patient should be closely monitored for 24 h
postprocedure Severe thrombocytopenia is not a contraindication to
BMA, as long as prolonged pressure is applied to the site to prevent
bleeding. For obese patients with severe thrombo cytopenia, in whom a
bone marrow biopsy is indicated, it is preferable to perform a platelet
transfusion to raise the p latelet count to over 15 × 109/L .
Skin infection or recent radiation therapy at the sampling site.
Bone disorders such as osteomyelitis or osteogenesis imperfecta.

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Risks:

● Excessive bleeding, particularly in people with low numbers of (platelets)

Infection, especially in people with weakened immune systems

● Long-lasting discomfort at the biopsy site

● Penetration of the breastbone (sternum) during sternal aspirations, which can harm
heart or lung .