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Bone Marrow Biopsy
Bone Marrow Biopsy
Bone marrow biopsy and bone marrow aspiration are invasive medical procedures to collect
and examine bone marrow — the spongy tissue inside some of your larger bones (see Figure
1). Bone marrow biopsy, also called trephination, is a procedure where a small sample of the
bone marrow is withdrawn by inserting a needle that passing through the outside portion of
the bone and into the middle of the bone where the marrow is located. The bone marrow
plays an important role in the human body. Bone marrow manufactures blood stem cells like
red blood cells, white blood cells, and the platelets. The blood stem cells, red blood cells,
white blood cells, and the platelets have a very important job.
Stem cells are found in bone marrow, and they develop into the three types of blood cells that
the body needs:
-Red blood cells, which carry oxygen to the tissues of the body;
-White blood cells, which fight infection by contributing to your immune system by
protecting the body against infectious diseases or foreign substances that enters the body;
-Platelets, which help the blood clot preventing the body from bleeding.
Bone marrow biopsy and aspiration can show whether your bone marrow is healthy and making normal
amounts of blood cells. Doctors use these procedures to diagnose and monitor blood and marrow diseases,
including some cancers – such as lymphoma, leukemia, and metastasis to bone marrow, as well as fevers of
unknown origin. The examination usually includes an aspiration and/or biopsy from the iliac crest (the top ridge
of the rear hipbone or pelvic bone). For babies and young children, the sample will be taken on a part of the
lower leg bone, just below the knee. When diagnosing Hodgkin’s lymphoma, an aspirate and biopsy are taken
from both sides. Sometimes, aspiration from the sternum is appropriate. In special cases, the aspiration is
performed with the help of image guidance in cooperation with the nuclear medicine department.
The type and caliber of the bone marrow biopsy needle is one of the main variables of the bone marrow
aspiration and biopsy procedure and is selected on the basis of the age, gender and body mass of the patient.
Bone marrow has a fluid portion and a more solid portion. In bone marrow biopsy, your doctor uses a needle to
withdraw a sample of the solid portion. In bone marrow aspiration, a needle is used to withdraw a sample of the
fluid portion.
Bone marrow biopsy and bone marrow aspiration are often done at the same time. Together, these procedures
may be called a bone marrow exam.
A bone marrow biopsy and aspiration can be done in a hospital, clinic or doctor’s office. The bone marrow
biopsy and bone marrow aspiration procedures are usually done by a doctor who specializes in blood disorders
(hematologist) or cancer (oncologist).
The bone marrow exam typically takes about 10 minutes. Extra time is needed for
preparation and post-procedure care, especially if you receive intravenous (IV)
sedation. The total time for the procedure is about 30 minutes.
The only contraindication for carrying out a bone marrow biopsy is serious
hemophilia. This must be performed in cooperation with a hemophilia clinic.
Trepanning is one of the oldest surgical operations known to man dating from 6500 BC, of 120 prehistoric
craniums 430 showed signs of trepanning. A trephine (from the Latin trypan) or auger is a cylindrical surgical
instrument of varying size and shape. Trepans are specially designed to obtain cylindrical fragments of bone
for analysis, or to drill through the cranium. In 1927, Anirkin, a Russian physician, obtained bone marrow
from the sternum using a lumbar puncture needle. Anirkin’s technique was used not only for the analysis of
bone marrow, but also for diagnosis of typhoid and tuberculosis. The technique continued to improve
throughout the 1940s and into the 1950s, when the pelvis was suggested as the collection site (Rubinstein
1950, Bierman 1952, Sacker and Nordin 1954) 1). In response to a 5% failure rate in obtaining samples,
McFarland and Dameshek (1958) described a trephination technique using the Vim-Silverman biopsy needle
(Silverman, 1938). These biopsies were performed using local anaesthesia, and several modifications were
made to the needle (1959–1963) (Figure 3B and 3C). Up to this point, all biopsy procedures were performed
in the outpatient setting. In 1971, Iranian hematologist Khosrow Jamshidi redesigned the needle so that the
interior diameter of the distal portion was tapered, allowing tissue to freely enter the lumen without fracturing
the core (Figure 3D). Some early attempts at designing electric drills were made between the 1960s and
1980s. However, due to the ease of use, efficacy and low cost of hand-held needles, these electric devices
were discontinued. Modern needles are similar in design to those used in the 20th century, and the procedure
is carried out under local anaesthetic to minimize patient discomfort 2).
Bone marrow biopsy needle