Bone marrow examination is an essential diagnostic procedure in medical field and also cancer research. The bone marrow specimens can be examined in cytological and histological point of view. Those specimens can be obtained by bone marrow aspiration, trephine biopsy, open biopsy as well as autopsy. Among these techniques, the complementary aspiration biopsy and trephine biopsy are the most important techniques for bone marrow research. Today, we are going to discuss about the bone marrow aspiration technique. We will talk about the trephine biopsy and others in the future posts.
Bone Marrow Aspiration Technique
First of all, we can explore about the history of bone marrow aspiration technique. Bone marrow was first acquired from living patients for diagnostic purposes and the bone marrow aspiration was introduced in the late 1920s. Since that, this technique has become an essential diagnostic approach in medical field. Unlike the trephine biopsy, bone marrow aspiration will trigger only mild discomfort to the patient.
Location of Bone Marrow Aspiration
Aspiration biopsy is usually worked on the sternum or the ilium. The useful diagnostic specimens up to the age of 18 months can be yielded by using aspiration from the medial surface of the tibia. Yet, the sterna aspiration has to be carried out from the first part of the body of sternum which is at the level of the second intercostals space. Another thing that we need to take precaution is the bone marrow aspiration from any lower in the sternum will increase the risk of this technique.
On the other hand, the aspiration from the ilium can be done either from the anterior or the posterior of iliac crest. When we wish to do the bone marrow aspiration as well as the trephine biopsy from adjacent sites, we have to make best use of the ilium. However, if there is no trephine biopsy to be done, we can either choose the sternum or iliac crest for aspiration. Both are suitable for adults and older children.
Comparison between Different Locations of Bone Marrow Aspiration
In cancer research, sterna aspiration was recognized to be technically easier and often produce suitable diagnostic specimen. Yet, this procedure is more painful if compare to the actual aspiration. Furthermore, this technique is more dangerous than others. Therefore, it is not suitable for use in young children. We can choose to use the posterior iliac crest aspiration for children, infants and also neonates. On the other hand, tibial aspiration can be used for very small babies.
Use of Bone Marrow Specimens by Aspiration
The specimens that produced by bone marrow aspiration can be used for:
- Preparation of wedgespread films and films of crushed marrow fragments
- Study of cell markers by either flow cytometry or on fims as well as cytospin preparations
- Cytogenetic study.
- Ultra-structural examination
- Culture for microorganisms
- Culture to study hematopoietic precursors and preparation of histological sections of fragments
As I mentioned before, the cytogenetic analysis is usually indicated in suspected hematological neoplasms. This analysis allows rapid diagnosis of suspected congenital karyotypic abnormalities like trisomy 18. We can get the diagnosis by using cytogenetic analysis within a day. However, if we use peripheral blood lymphocyteds, we need 3 days to get the diagnosis.
Despite of this, bone marrow aspiration technique could fail too. We call this failure as dry tap. The dry tap occurred usually refers to the serious diseases like metastatic cancer, chronic myeloid leukemia, idiopathic myelofibrosis or hairy cell leukemia with associated fibrosis. Therefore, the bone marrow examination is not easy to be done. I think most of the time I will deal with this procedure when I start my bone marrow cancer research on cytogenetics. I will talk about another technique for bone marrow examination, the trephine biopsy in future post in Cytogenetics Cancer Research blog.
(Reference: Bone Marrow Pathology written by Barbara J. B., David M. C., Irvin A. L. and Bridget S. W.)