Bone marrow aspiration is performed to obtain biopsy marrow to diagnose hematologic diseases such as leukemia, malignant lymphoma, or plamacytoma. Before transfusion of blood products (bone marrow donation), the donor’s bone marrow is tested for compatibility.
What is bone marrow aspiration?
A bone marrow aspiration is performed to obtain biopsy marrow to diagnose hematologic diseases such as leukemia, malignant lymphoma, or plamacytoma. Bone marrow aspiration is a minor procedure (15 minutes) and is performed by puncturing the bone marrow, preferably in the iliac crest or sternum (breastbone). The procedure is performed under local anesthesia with a special cannula to obtain biopsy material. For this reason, this puncture procedure is also called a bone marrow biopsy. The physician removes a small amount of bone marrow from the breastbone (sternum) or the posterior iliac crest. In the laboratory, the different blood cells are easily seen under a microscope.
Function, effect, and goals
The bone marrow forms the majority of blood cells in the human body. It is, with few exceptions, the origin of all blood cells and forms inside the bones. Bone marrow is the prerequisite for proper hematopoiesis and should not be confused with the spinal cord, which runs through the center of the spine and is composed of nerve cords. The nerve cords connect the nerve conduits to the brain. The stem cells, also called blasts, form the precursor of blood cells. These stem cells and a certain number of mature blood cells are found in the meshes of bone tissue. Consequently, a bone marrow puncture should be seen separately from a spinal cord puncture. Medicine distinguishes three cell systems. The erythrocytes (red blood cells) are responsible for oxygen transport. The leukocytes (white blood cells) serve to fight pathogens. The platelets (thrombocytes) ensure proper blood clotting. A bone marrow puncture is performed if the patient is suspected of having a diseased hematopoietic system. Bone marrow biopsy can also be used to monitor progress. Diseases that can be reliably diagnosed by biopsy are specific forms of anemia, various types of leukemia, in which there is a disease of the white blood cells, and a reduction in the blood-forming cell forms (bone marrow aplasia). The reverse variant, the proliferation of all cell systems (polycythaemia vera) is also detected in this way. Physicians detect daughter tumors of certain tumor types, such as breast cancer and prostate cancer, which can accumulate in the bone marrow. Diseases of the lymphatic system, such as lymphomas, are also diagnosed with the help of this procedure. Preferably, a punch biopsy of the pelvic bones is performed, usually at the posterior iliac crest. In the case of patients under intensive medical care, physicians also deviate to the anterior iliac crest. Sternal bone marrow puncture is performed only in exceptional cases when the posterior iliac crest cannot be palpated due to severe obesity. The cells obtained from the collection material are examined microscopically and provide information on cell density and the number of individual cell types (platelets, white and red platelets). The puncture site is dressed with a plaster. The patient is given a small sandbag to place under the posterior pelvic area, on which he or she must remain for a while to stop the bleeding.
Risks, side effects, and dangers
A major focus of hematology is the collection of tissue and blood samples to facilitate subsequent diagnosis, as physicians gain important knowledge from characterizing tissue cells and analyzing blood components to evaluate malignancies. In many cases, blood or tissue sampling is the first step in the diagnosis and treatment of many cancers. Differentiation of the blood count is done by an ordinary blood draw. Under the microscope, doctors can detect abnormally changed cells. During the bone marrow biopsy, doctors remove the bone marrow from the posterior iliac crest because there is no risk of injury to surrounding organs at this site. The patient lies on his side with his legs bent or in an extended prone position. Puncture of the sternum is performed in the supine position.The puncture site is disinfected and locally anesthetized. A puncture needle is inserted through the skin and bone substance into the bone marrow. A small bone marrow cylinder (punch biopsy) is taken from this puncture site. Alternatively, the collection is done via a syringe placed on the puncture needle, which is used to aspirate a small amount of bone marrow by a short, forceful pull (aspiration). Physicians usually refrain from sternal puncture because it is more painful than removing tissue from the posterior iliac crest. There is a greater risk of injury to the surrounding organs of the chest, such as the heart and lungs, and to the major blood vessels in the immediate vicinity of the puncture needle. A sedative or analgesic is not usually necessary, but may be administered if requested by the patient. Additional molecular genetic or immunological tests may be performed to examine the material obtained. If tumor disease is diagnosed by bone marrow aspiration, the initial findings may be followed by so-called staging diagnostics. This comprises examinations that divide a tumor disease or leukemia into different stages. In addition to physiological examinations, imaging diagnostics (mammography, computer tomography, sonography, magnetic resonance imaging, nuclear medical examinations, PET-CT) are possible. Endoscopy (reflection), laparoscopy (abdominal endoscopy) or endosonography complement the previous examinations, if necessary. This procedure is often performed on an outpatient basis. Physicians advise their patients to avoid physical exertion in the hours following the puncture and to refrain from active participation in traffic within the next 24. Bone marrow biopsy is a procedure that does not usually result in complications. Nevertheless, physicians advise their patients of possible complications prior to the procedure, but these are rare. When sedatives and painkillers are administered, irregularities in respiratory function may occur. Bruising and secondary bleeding may occur in the immediate vicinity of the puncture site. Injury to surrounding organs, nerves, soft tissues, or skin is possible.
