Our bones contain some spongy tissues called bone marrow. This bone marrow creates bone marrow stem cells and other substances which are further responsible for producing blood cells. The types of blood cells which our bone marrow produces perform significant functions in our body which include:
- White blood cells are responsible for fighting against infections and germs.
- Red blood cells are responsible for carrying oxygen to the tissues of the body.
- Platelets help the blood to clot and thus stop bleeding.
Sometimes doctors order a bone marrow test. The purpose of doing a bone marrow test is to diagnose and monitor blood and marrow diseases. These tests include bone marrow aspirations and biopsies. These procedures ensure that you have healthy bone marrow which is creating normal amounts of blood cells.
Our bone marrow is a combination of a fluid and a more solid portion. The withdrawal of a sample of the fluid portion with the help of a needle is known as bone marrow aspiration whereas the withdrawal of a sample of the solid portion with the help of a needle is referred to as bone marrow biopsy. Bone marrow aspiration can be done alone but usually, it is combined with a bone marrow biopsy. Both of these terms are collectively known as bone marrow exams.
Why a bone marrow exam is performed?
A bone marrow exam helps in acquiring detailed information about your bone marrow and blood cells. Normally it is performed if the blood tests are abnormal or the doctor wants detailed information about a suspected problem. Your doctor might order a bone marrow exam because of the following reasons:
- To monitor the treatment of a disease
- To find out the reasons for a fever whose reasons are not clear
- To determine if the iron levels are adequate
- To check the stage of a disease
- To check the progression of a disease
- To diagnose a disease that involves bone marrow or blood cells
It can be ordered to diagnose some other conditions including:
- Anemia
- Blood cells conditions such as leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, pancytopenia, and polycythemia
- Cancers of the bone marrow or blood (leukemia, lymphomas, and multiple myeloma)
- Cancers that spread from another part for example from the breast to the bone marrow
- Hemochromatosis
- Fevers of unknown origin
What is a bone marrow biopsy tray?
A bone marrow exam is performed with the help of a bone marrow biopsy tray which includes many options to help in aspiration and capturing bone marrow samples. This tray includes all the things that are needed to collect a sample of the bone marrow.
What is in a bone marrow biopsy tray?
A bone marrow biopsy tray or a bone marrow aspiration tray consists of the following contents:
Povidone-iodine antiseptic solution
A Povidone-iodine antiseptic solution is used to cleanse the chosen site for taking the sample. It also includes the necessary drapes which help maintain sterility at the site.
Lidocaine solution
A 1 or 2 percent of lidocaine solution is a part of the bone marrow biopsy tray which is used as local anesthesia, along with a sterile syringe, a 23-gauge, and a 21-gauge needle.
Scalpel blade
To insert the aspiration or biopsy needles skin incision is done with the help of a number 11 scalpel blade.
Sterile gauze and bandages
In order to clean the biopsy site sufficient quantity of sterile gauze and bandages are a part of the bone marrow biopsy tray. These are also used to apply local pressure after the completion of the procedure to insure hemostasis.
Needles
The bone marrow biopsy tray should include a large selection of needles for aspiration. A needle that can be fixed in place and contains a stylet is preferred. It is also highly significant to choose the right needle for the procedure. For example, the needle should be long enough to penetrate through the subcutaneous tissues and into the marrow cavity. Also, a sharp needle should be used for the procedure.
Jamshidi biopsy needle
A Jamshidi biopsy needle with a stylet and an obturator should be a part of the bone marrow tray which is used for removing the biopsy core from the needle without damaging the specimen.
However, certain details should be investigated carefully before performing a bone marrow biopsy. These include the choice between performing a bone marrow aspiration or a bone marrow biopsy. The choice of a bone marrow test depends upon the patient’s clinical scenario and the diagnosis that is being considered.
Also, the selection of the site of the biopsy or aspiration is another critical choice. In adults, children, and most infants the posterior superior iliac crest and spine is the favored site of examination. The reason is that the patient feels the least discomfort at this site as compared to the others. However, bone marrow aspiration or biopsy can be done using the anterior iliac crest or greater trochanter of the femur, individual vertebral bodies, or ribs in selected cases.
Post-procedure instructions
After the aspiration or biopsy procedure is completed, the patient should lie in a supine position in order to apply body weight to the biopsy site for almost 15 minutes. After this, the patients should be examined to make sure there is no further bleeding. If the patient continues to bleed at the site of aspiration or biopsy after this period, pressure should be reapplied to the site and the patient should be asked to lie supine for at least an hour. If the blood flow does not stop even after this duration, then it may be necessary to transfuse platelets if the patient is severely thrombocytopenic or if platelet function is suspected to be compromised. The patient should be told the following instructions to avoid any complications.
Pain control
In order to control the pain, the patient should be prescribed a dose of acetaminophen 650 mg orally which is usually adequate. This dose can be prescribed after every four to six hours for the next one or two days.
Swelling, pain, or further bleeding
The patient should be advised to immediately contact the doctor or clinic if he notices any swelling, increasing pain, tenderness, or further bleeding.
Avoid overexertion
The patient should be asked to avoid overexertion for at least 24 hours to help the healing procedure. If it is not followed the patient may experience pain and bleeding at the site of the procedure. A small dressing or bandage should be used to keep the site of aspiration or biopsy site dry during this time to minimize the risk of bleeding or infection.
Conclusion
Bone marrow aspiration and bone marrow biopsy are two complex procedures that should be performed with great attention. These two procedures are extremely helpful in diagnosing and treating several medical conditions including cancers and fevers of unknown origin. From choosing between both of these tests to completing the procedure successfully, every part of this procedure should be carefully monitored by a physician. The bone marrow biopsy or aspiration tray is the main component in this procedure which includes all the necessary components that are required to complete this procedure successfully.
