Bone marrow aspiration and biopsy
Bone marrow aspiration and biopsy are medical procedures used to collect samples from the bone marrow, the tissue responsible for producing blood cells. These procedures are essential for diagnosing various blood disorders, including hematological malignancies such as leukemia, multiple myeloma, and polycythemia vera, as well as assessing the overall function of the bone marrow. Typically performed by hematologists or other trained specialists, the aspiration and biopsy usually target the pelvic bone or the sternum, which are optimal sites for obtaining quality samples.
Before the procedure, patients receive explanations and consent is obtained. A local anesthetic is administered to minimize discomfort, although some pressure and brief shooting pain may be experienced during the process. Following sample collection, patients may experience soreness at the site, and precautions are taken to prevent bleeding, particularly in those with low platelet counts. While risks are minimal, they can include infection, bleeding, and in rare cases, injury to nearby organs.
The analysis of the collected samples helps physicians determine the presence of cancerous cells, evaluate treatment efficacy, and monitor disease progression. Overall, these procedures play a vital role in the management of blood-related health issues and can offer crucial insights into a patient’s condition.
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Bone marrow aspiration and biopsy
DEFINITION: Bone marrow aspiration involves the removal of a bone marrow sample for laboratory examination. The bone marrow is where all blood cells are created. The bone marrow's job is to replace dead and dying red blood cells, white blood cells, and platelets. At times, cancer or other disease may cause this bone marrow production to stop or decrease. Sites for bone marrow aspiration and biopsy are typically the pelvic bone (ilium) or the sternum, larger bones that provide the best samples. A hematologist, medical oncologist, internist, pathologist, or specially trained technologist can perform a bone marrow biopsy. The patient can have a bone marrow biopsy at the bedside, in interventional radiology, and even in the operating room.
Cancers diagnosed:Leukemia, multiple myeloma, or polycythemia vera, cancers referred to as hematological malignancies; metastatic cancer
Why performed: A bone marrow biopsy is done to evaluate the functioning of the bone marrow and to determine the presence or absence of cancer.
Patient preparation: The patient will have the procedure explained and provide consent. A numbing medication is injected at the site; it may burn or sting when used. Once the numbing medication is injected, patients usually feel considerable pressure at the site but not necessarily pain during the procedure. When the biopsy is done in the hip, patients occasionally complain of a quick shooting pain down the leg, but it usually stops once the sample has been taken. A patient with a low platelet count may receive a platelet transfusion immediately before the procedure.
Steps of the procedure: The patient will be positioned for the procedure and needs to remain still until its completion. A patient who is having the pelvic bone biopsied will be placed on one side with pillows or blankets used to maintain positioning. A patient who is having the sternum biopsied will lie flat on the bed or the table. The patient may be given medication for pain and relaxation. The site is scrubbed and cleaned, and then the patient is given medication to numb the site. A small cut is made into the skin. The procedure is done with a device consisting of a large hollow needle with an inner attachment (cannula) that allows the bone to be accessed. The needle is used to make a hole in the bone. Once it is inside the bone, the middle of the needle is removed, and the sizeable hollow needle rests in the center of the bone. A large syringe is used to extract a marrow sample (aspirate). The section of bone taken when the inner cannula was removed from the needle is also kept for pathology testing. The patient may have this procedure done on both hip bones or at multiple sites to establish the staging of the disease. The samples are placed on slides or in a liquid to preserve them until testing can be completed.
After the procedure, Pressure may need to be applied to prevent bleeding. The patient may be asked to lie on that hip to provide extra Pressure immediately after the biopsy for ten to fifteen minutes. The cut is typically small enough that a bandage and a little pressure are all needed. Some patients may not be able to stop bleeding after the biopsy, usually because their platelet counts are too low. These patients may require a stitch at the bone marrow site to stop the bleeding. Patients may remain sore at the site for two to three days after the procedure. If this procedure was performed on an outpatient, the patient would not be able to drive home and would need a family member or friend to help.
Risks: The risks from performing a bone marrow aspiration and biopsy are minimal. As with any invasive procedure, there is a risk of infection, bleeding, and bruising. If the sample is taken from the sternum (breast bone), then there is a risk of injury to the heart, lungs, and major blood vessels.
Results: The findings from the bone marrow aspiration and biopsy show the types of cells in the bone marrow. The hematologist or pathologist examines the samples with a microscope to determine the types of cells present. The physicians can determine if these cells are normal, misshapen, or cancerous and the stage of the cancer that may be present.
Bone marrow biopsies are also done to evaluate therapy. This is typically seen in leukemia patients. They will have a bone marrow biopsy completed before treatment and then a biopsy done at or around day fourteen to determine if the chemotherapy has destroyed the cells in the bone marrow.
According to the Fred Hutchingson Cancer Center, in 2022, a new approach was employed to better prevent transplanted cells from attacking the healthy tissues of a recipient. The negative side effects can vary in intensity. The new approach cleared some immune cells out of the recipient but strengthened the anti-tumor capabilities of immune cells left behind. This method was reported to help prevent relapses in bone marrow transplantation to treat leukemia and multiple myeloma.
Bibliography
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