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Bone Marrow Biopsy Techniques
Bone Marrow Biopsy Techniques
Thiruselvame,
M. V. Sc.
Two procedures
1. Bone marrow aspirates
2. Bone marrow core biopsy
Steps:
I. Preparing equipment
II. Patient preparation and sedation
III. Placement of the sampling needle
IV. Procuring the sample
V. Preparing slides
VI. Confirming adequate sampling
VII. Submitting samples to the lab or interpreting results
in house
Comments about the Bone Marrow Aspiration
• Iliac crest
• Ribs
• Sternum
Choosing a Site
Proximal humerus
– As an IM pin would be placed.
– Preferred for severe thrombocytopenia
• Less soft tissue to go through
• Direct pressure for primary hemostasis easily applied
Proximal femur
– Easier in the cat
Rosenthal needle
– 100 % metal (steel) Rosenthal can be re-autoclaved
– May need to be sharpened occasionally
– 16 - 18 Gauge - not for biopsy
• Sterile supplies:
– Supplies for animal sedation
– Surgical gloves
• keep paper wrap for sterile field
– Drape
– #11 blade
– Bone marrow needle
– 10 ml syringes
– 18 Gauge needles
Preparing equipment
• Non-sterile supplies:
– Surgical prep equipment
– EDTA or heparin
– Petri dish
– Pipettes
– Microscope slides
– Microscope
• Sedate
• Re-scrub
• Drape aseptically
Proximal Humerus –
“IM pin” method
• Lateral recumbency
• Rotate elbow medially & push humerus cranially to expose the shoulder
• Stab incision # 11 blade on “flat spot” between the greater tubercle and the
humeral head
• Thumb of other hand holding elbow along long axis of humerus for reference
• Line needle up parallel with the long axis of the humerus (other thumb)
• Then screwdriver-like motion until needle well seated in the marrow cavity
– Remove needle
• Remove the cap and stylet from the bone marrow needle and
place on the sterile field
• Firmly attach the coated syringe
• Rapidly pull plunger back to 8 - 10 ml
– This hurts
• As soon as you see blood, release pressure, and get 1 ml
or less of bone marrow
• Very quickly squirt the marrow into the Petri dish, and
swirl
• Look for spicules (“flecks”)
• If no spicules, remove needle and try again
• If spicules, replace the marrow needle cap and prepare
slides to confirm good sample
Proximal Humerus – lateral technique
Iliac Crest – dorsal technique:
• Sternal recumbency, hind limbs tucked under
• Palpate “flat spot” on the iliac crest (Impossible in obese dogs; Easy in cats)
• The needle has a tendency to slide off the iliac crest medially or laterally, so
do this step slowly and firmly Using the guide-piece of an Illinois needle
can help control how far the needle penetrates if it slips off the crest
Iliac Wing – lateral technique:
• Not recommended for cats or small dogs (less than 10 Kg)
• Lateral recumbency
• Palpate “flat spot” on the iliac crest
• Insert the needle 1 - 2 cm ventral to the center of the iliac crest
• Axis of the needle is perpendicular to the long axis of the ilium and
perpendicular to the table
• Careful not to advance the needle through the opposite cortex
• Jamshidi needle can be used to take a full thickness marrow biopsy
Proximal femur
• Easier in the cat
• Lateral recumbency
• Rotate stifle slightly medially
• Place thumb along long axis of femur,
pointing proximally, and ending on greater
trochanter
• Insert the needle under thumb, into the
inter-trocantric fossa
• Axis of the needle is parallel to the long
axis of the femur
• Remember the sciatic nerve runs caudal to
the femur
Slide Preparation
Aspiration or Core Biopsy?
Advantages of aspiration
• Cellular morphology is more clear
– Better identification of cell lineages
– Characteristics of malignancy
– Myelofibrosis
Fat (adipose)
Both of the illustrated particles have > 75% cellularity (< 25 % fat)
Bone Marrow Cells Types:
• Stem cells
• Erythroid cells
• Granulocytic cells
• Monocytic cells
• Megakaryocytic cells
• Lymphocytic cells
• Stromal cells (supporting cells)
Erythrocyte and Granulocyte Maturation
Megakaryocytes
Scan at low power for large purple multi-nucleated (30 - 50) cells
Increased if regenerative thrombocytopenia or iron deficiency
Decreased if non-regenerative or acute severe thrombocytenia
Megakaryocytes
Megakaryocytes
• Hyperplasia
• Hypoplasia
• Neoplasia
• Fibrosis
• Inflammation
• Infarction
Other cells found in bone marrow:
• Vascular system cells
– Supply nutrients to the marrow
• Reticular cells
– Give structure to the marrow
Always cover
with Pain management!
This hurts!
Submitting Samples