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The Mystery of Bone Marrow Examination: How to Reveal the Hidden Secrets in Your Blood?
A bone marrow examination is a pathological analysis procedure in which a bone marrow sample is obtained through a bone marrow biopsy (often called a needle biopsy) and a bone marrow aspirate. This test is used to diagnose a variety of conditions, including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia. Bone marrow is where blood cells are made, including platelets, red blood cells, and white blood cells. While a lot of information can be gained from blood tests, sometimes it is necessary to directly examine the bone marrow from which the blood comes to gain a deeper understanding of the hematopoietic process; this is what bone marrow aspirates and biopsies are used for.
Bone marrow examinations are not only key to the industry, but also an exploration of the inner workings of the human body and an indicator of a patient's health.
Components of a program
Obtaining a bone marrow sample usually involves two procedures: aspiration and needle biopsy. Sometimes, a bone marrow exam involves both an aspiration and a biopsy. An aspiration can obtain a semi-liquid sample of bone marrow, which is examined by a pathologist using a light microscope and analyzed by flow cytometry, chromosomal analysis, or polymerase chain reaction (PCR). A needle biopsy is often performed to obtain a narrow, cylindrical piece of solid bone marrow, approximately 2 millimeters in diameter and 2 centimeters (80 microliters) long, which is examined under a microscope (sometimes using immunohistochemistry). Check the cell properties and infiltration status. The aspiration process typically uses a 20 ml syringe and is capable of obtaining approximately 300 microliters of bone marrow sample. It is recommended that the volume obtained should not exceed 300 microliters, as too much sample may arrange the surrounding blood and affect the test results.
Check location
Bone marrow aspirates and needle biopsies are usually performed at the back of the hip bone (i.e., the posterior iliac ridge), but samples can also be taken from the sternum. For sternal aspiration, the patient lies on their back with pillows under their shoulders to elevate their chest. Sternal needle biopsy should be avoided in this location because of the risk of damage to blood vessels, lungs, or heart. For children under 2 years old, the tibial area of the hip can also be used for bone marrow aspiration, and spinal cord puncture is often performed at the L3-L4 spine. Anesthesia reduces superficial pain at the site where the needle is inserted, but the patient may still feel twinges of pain due to the throbbing bone marrow. Reports of pain vary from patient to patient, and some patients may not experience pain at certain expected points.
Test execution
A bone marrow biopsy can be done in a medical provider's office or in a hospital. This procedure usually requires informed consent from the patient, who is asked to lie on their stomach or side. The skin is then cleaned and a local anesthetic such as lidocaine or procaine is injected to numb the area. Although uncommon, patients sometimes receive pain relievers and/or anti-anxiety medications beforehand. Typically, suction is performed first, with a skilled clinician inserting an aspiration needle through the skin until it reaches the bone and then advancing the needle with a twisting motion. When the needle enters the bone marrow cavity, a syringe is attached and the liquid bone marrow is aspirated. The needle should be twisted slightly when drawing to avoid excessive blood seeping into the sample, which will affect the final test results. Next, a biopsy is performed if necessary, which is done using another larger needle to obtain a piece of solid bone marrow. The entire process usually takes 10 to 15 minutes after preparation is complete.
Relative contraindications
There are few contraindications to bone marrow examination. It should be noted that thrombocytopenia or bleeding disorders are not contraindicated as long as it is performed by a skilled clinician. Even in cases of extreme thrombocytopenia, bone marrow aspiration and biopsy can be performed safely. If there is a skin or soft tissue infection above the hip, another site should be chosen for bone marrow examination.
Complications
While mild pain usually lasts 12 to 24 hours after the test, serious complications are extremely rare. In a large-scale review, 26 serious adverse events (using a 0.05% scale) were recorded from an estimated 55,000 bone marrow examinations, including one death. Another study conducted in the UK in 2003, covering more than 19,000 bone marrow examinations, recorded 16 adverse events (0.08% of total procedures), with bleeding being the most common. Although complications are rare, they can be very serious in individual cases.
With the development of bone marrow examination, more and more medical professionals are conducting in-depth research and discussion on this procedure to discover information that may have a significant impact on patients' health. This is not only a technical issue of the examination, but also the thinking of medical staff on how to better use this examination. Therefore, we might as well think about how the future application of bone marrow examination will change our understanding of disease diagnosis and the way we manage health?
