Bone marrow - nonneoplastic
General
Biopsy and aspirate smear

Author: Nat Pernick, M.D. (see Authors page)

Revised: 29 June 2017, last major update December 2006

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Bone marrow biopsy and aspirate smear

Cite this page: Biopsy and aspirate smear. PathologyOutlines.com website. http://pathologyoutlines.com/topic/bonemarrowbiopsy.html. Accessed December 12th, 2017.
Technique
  • Trephine:
    • A surgical instrument having circular, saw-like edges used to cut out disks of bone, usually from the skull
  • Trephine biopsy:
    • Biopsy of a portion of bone containing marrow
  • Jamshidi type biopsy needle:
    • Recommended, usually 11 gauge
  • Other needles:
  • Ultrasound decalcification may allow more successful FISH, PCR and RT-PCR (Am J Surg Pathol 2006;30:892)
  • Note: FISH can be performed on tissue imprints, cytopreps or bone marrow aspirate smears (J Clin Pathol 2005;58:629)
  • Note: trephine biopsy may also reveal bone disorders not the reason for the biopsy
Sites
  • Posterior superior iliac spine
  • Alternative site may be necessary in obese patients
Diagrams / tables

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Schematics

Uses by pathologists
  • To evaluate:
    • Leukemia
    • Lymphoma and lymphoproliferative disorders
    • Myeloproliferative or myelodysplastic disorders
    • Metastatic disease
    • Aplastic anemia and other hematologic conditions
    • Infectious and metabolic disorders
    • Also to evaluate postchemotherapy cellularity and post bone marrow transplant engraftment
  • Should be accompanied by aspirated marrow smears and particle crush preparations and by touch imprints from trephine biopsy
Complications
  • Adverse events in 0.8% (J Clin Pathol 2005;58:406)
  • Major complication is hemorrhage / hematoma (apply pressure bandage to biopsy site to prevent; obtain coagulation consultation if patient has bleeding disorder or is on anticoagulants)
  • Risk factors for hemorrhage are myeloproliferative disorder, aspirin, other putative platelet dysfunction and thrombocytopenia
Processing of trephine biopsy
  1. Make imprints from trephine biopsy by gently touching glass slide to specimen
  2. Possibly freeze part of trephine biopsy for molecular studies (J Clin Pathol 2006;59:1111)
  3. Fix tissue in formalin, B5 or Zenker
  4. Decalcify for 45 - 60 minutes
  5. Embed in paraffin
  6. Section at 3 - 4 micron intervals, saving tissue for possible special stains and molecular studies
Processing of aspirate
  • Place some aspirate in EDTA, make smears at bedside with remainder
  • Make smears from buffy coat (nucleated cell layer) and particles
Steps
  1. Position patient properly (MedlinePlus: Bone Marrow Aspiration)
  2. Prepare and sterilize the site with iodine solution
  3. Anesthetize skin and bone with lidocaine
  4. Nick the skin with a blade to facilitate needle insertion
  5. Insert bone marrow aspiration needle
  6. Aspiration needle in place with trochar (white) partially withdrawn
  7. Syringe for aspirating bone marrow is in place
  8. Part of aspirate is put into EDTA tube to prevent clotting
  9. Part of aspirate is put on slide to pick particles
  10. Aspirate smear is made using another slide
  11. Biopsy needle is inserted at same site
  12. Feel the give of the needle as it enters the cortex
  13. Withdraw the trochar from the needle
  14. After another centimeter push, rotate the needle to cut the end of the specimen
  15. Withdraw the needle with the specimen inside the needle
  16. Push the biopsy specimen from the narrow end to the hub end with the trochar
  17. Place the biopsy specimen in fixative (such as Zenker) for decalcification and processing
Clinical images

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Blood clot

Microscopic (histologic) description
  • Bone marrow biopsies are helpful to determine cellularity and presence of fibrosis
  • Purple granular deposits that impair evaluation of touch preparations are due to cartilage in biopsy and are more common in children (J Clin Pathol 2003;56:883)
Microscopic (histologic) images

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Poor technique

Smear: good and poor technique

Epoxy resin embedded bone marrow biopsies

Molecular / cytogenetics images

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FISH from tissue imprints