Bone marrow nonneoplastic
General
Biopsy and aspirate smear
Author: Nat Pernick, M.D.
Last author update: 1 December 2006
Last staff update: 11 July 2019
Copyright: 2002-2019, PathologyOutlines.com, Inc.
PubMed Search: Bone marrow biopsy and aspirate smear
Table of Contents
Technique | Sites | Diagrams / tables | Uses by pathologists | Complications | Processing of trephine biopsy | Processing of aspirate | Steps | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Molecular / cytogenetics images | Additional referencesCite this page: Pernick N. Biopsy and aspirate smear. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bonemarrowbiopsy.html. Accessed December 23rd, 2024.
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:
- Single use needle (Biomed Instrum Technol 2005;39:391) for neonates (Br J Haematol 1999;107:458)
- Recommended to use separate needles for trephine biopsy and aspiration (J Clin Pathol 2007;60:212)
- Can use same skin incision but sites a few millimeters apart
- Bilateral biopsies useful if disease is likely focal (lymphoma or metastatic tumors, Cancer 2002;94:1522)
- 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
Images hosted on other servers:
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
- Make imprints from trephine biopsy by gently touching glass slide to specimen
- Possibly freeze part of trephine biopsy for molecular studies (J Clin Pathol 2006;59:1111)
- Fix tissue in formalin, B5 or Zenker
- Decalcify for 45 - 60 minutes
- Embed in paraffin
- Section at 3 - 4 micron intervals, saving tissue for possible special stains and molecular studies
- Some laboratories prefer plastic embedding, which may provide superior cytologic detail (J Clin Pathol 2005;58:897)
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
- Position patient properly (MedlinePlus: Bone Marrow Aspiration)
- Prepare and sterilize the site with iodine solution
- Anesthetize skin and bone with lidocaine
- Nick the skin with a blade to facilitate needle insertion
- Insert bone marrow aspiration needle
- Aspiration needle in place with trochar (white) partially withdrawn
- Syringe for aspirating bone marrow is in place
- Part of aspirate is put into EDTA tube to prevent clotting
- Part of aspirate is put on slide to pick particles
- Aspirate smear is made using another slide
- Biopsy needle is inserted at same site
- Feel the give of the needle as it enters the cortex
- Withdraw the trochar from the needle
- After another centimeter push, rotate the needle to cut the end of the specimen
- Withdraw the needle with the specimen inside the needle
- Push the biopsy specimen from the narrow end to the hub end with the trochar
- Place the biopsy specimen in fixative (such as Zenker) for decalcification and processing
Clinical images
Images hosted on other servers:
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
Images hosted on other servers:
Poor technique
Smear: good and poor technique
Epoxy resin embedded bone marrow biopsies
Molecular / cytogenetics images
Images hosted on other servers:
FISH from tissue imprints
