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A Surprising Bone Marrow Biopsy: Why This Procedure Is Crucial for Diagnosing Cancer?
A bone marrow examination is a pathological analysis of bone marrow samples, which are usually obtained through a bone marrow biopsy (also called a needle biopsy) and a bone marrow aspirate. This procedure is used to diagnose a variety of conditions, including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia. Bone marrow is where blood cells are produced, including platelets, red blood cells, and white blood cells. While drawing blood from a vein (phlebotomy) can yield a wealth of information, sometimes we need to examine the source of the blood cells—the bone marrow—to get more information about the blood-making process; this is the role of a bone marrow aspirate and biopsy.
Components of a program
Methods of obtaining bone marrow samples include aspiration and needle biopsy. In some cases, a bone marrow exam includes both an aspirate and a biopsy. The semi-liquid bone marrow sample produced by the aspiration can be examined by a pathologist under a light microscope or analyzed by flow cytometry, chromosomal analysis or polymerase chain reaction (PCR). A needle biopsy is usually performed, which produces a small, cylindrical sample of solid bone marrow, about 2 mm wide and 2 cm long (80 μL), which is examined under a microscope and sometimes supplemented by Immunohistochemical techniques were used to examine cell density and infiltrative processes.
One aspiration using a 20 ml syringe typically yields approximately 300 microliters of bone marrow sample.
Where the procedure takes place
A bone marrow aspirate and needle biopsy are usually performed on the back side of the hip bone or on the posterior wing ridge. Aspirate samples may also be obtained from the sternum. During sternal aspiration, the patient usually lies on his or her back with pillows placed under the shoulders to elevate the chest. A needle biopsy of the sternum should not be performed because of the risk of damage to blood vessels, lungs, or heart. In children under 2 years of age, bone marrow aspiration can be performed at the tibia, while vertebral body aspiration is often performed at the lumbar puncture site (L3-L4 intervertebral space). This procedure uses anesthetic medication to reduce superficial pain at the needle site.
Inspection process
A bone marrow biopsy can be done in a medical provider's office or in a hospital. Informed consent is usually required before the procedure begins. The patient will be asked to lie prone (lying on their stomach) or on their side. The skin is then cleaned, and a local anesthetic such as lidocaine or procaine is injected to numb the area. Patients may also be given painkillers or anti-anxiety medications before the procedure, although this is not a routine practice. Generally, aspiration is performed first, with an aspiration needle inserted through the skin and manual pressure applied until the bone is reached, and then the needle is advanced deep into the medullary cavity in a spiral motion. After the needle enters the bone marrow cavity, a syringe is connected to extract the bone marrow. To avoid excessive blood concentration in the sample, wrist rotation during needle insertion is very important. Then, if needed, a biopsy will be taken.
The entire process usually takes about 10 to 15 minutes after preparation is completed.
Contraindications
There are a few contraindications to bone marrow examination. It is important to note that thrombocytopenia or bleeding disorders are not contraindications as long as the procedure is performed by a skilled clinician. In the setting of extreme thrombocytopenia, bone marrow aspirates and biopsies can still be performed safely. If the skin or soft tissue of the hip is infected, another site should be chosen for bone marrow examination.
Potential complications
Although mild discomfort may last 12 to 24 hours after a bone marrow exam, serious complications are extremely rare. According to a large-scale review, there were only 26 serious adverse events (0.05%) among an estimated 55,000 bone marrow examinations, including one fatal event. Another survey conducted in the UK in 2003 counted more than 19,000 bone marrow examinations and recorded 16 adverse events (0.08% of total procedures), with the most common problem being bleeding. Although complications are rare, they can be serious in individual cases.
Patients are usually asked to lie flat for 5 to 10 minutes after the procedure to apply pressure to the sampling site.
Conclusion
Through bone marrow biopsy, the medical team can obtain important information about the blood system, which can help diagnose serious diseases such as cancer. While many people fear this procedure, it is a lifeline to a correct diagnosis for many patients. With the continuous advancement of medical technology, the safety and effectiveness of this examination are also constantly improving. So how do we choose when the urgency of diagnosing a condition meets the horror of a health experience?
