BONE MARROW - AMPA, Morsidah S.

EXTRACTION
BONE MARROW EXTRACTION

- provides a semi-quantitative and qualitative

assessment of the state of hematopoiesis and aids
in the diagnosis of several hereditary and
acquired benign and malignant diseases.
BONE MARROW
- consists of large, undifferentiated stem cells
supported by fibrous tissue called stroma

2 MAIN TYPES OF STEM CELLS:

 Hematopoeitic stem cells
 Mesenchymal stem cells

Average weight : 4% of the total body weight

Red marrow - flat bones, such as the hip bone, sternum, skull, ribs,
vertebrae, and shoulder blades, as well as in the metaphyseal and
epiphyseal ends of the long bones
Yellow marrow - hollow interior of the diaphyseal portion or the shaft
of long bones.
BONE MARROW EXAMINATION
1. ASPIRATION - for cytologic assessment
2. BIOPSY - allow evaluation of the marrow’s overall cellularity

- can be carried out as an office procedure on ambulatory

patients with minimal risk
- compares favorably with ordinary venipuncture and is less
traumatizing than a lumbar puncture.
INDICATIONS

• Diagnosis, staging, and therapeutic monitoring for

lymphoproliferative disorders
• Evaluation of cytopenia, thrombocytosis, leukocytosis,
anemia, and iron status
TECHNICAL CONSIDERATIONS
Posterior superior iliac crest
- employed site for reasons of safety, decreased risk of pain, and
accessibility. The posterior superior iliac crest site is localized to the central
crest area.

Anterior superior iliac crest

- alternative site

Sternum
- last resort in those older than 12 years and in those who are morbidly obese

Tibia
- sampled only for infants younger than 1 year
PATIENT PREPARATION
Anesthesia
- Local anesthesia
- General anesthesia

Positioning
ASPIRATION
Skin and site preparation
1. Puncture the skin with the BMA needle and
advance to the periosteum, then enter the bone
marrow space with a twisting motion until the needle is
firmly anchored in the bone
2. Remove the stylet and attach a 5 mL syringe to
the needle hub. Apply strong suction to obtain no more
than 0.3 mL to 0.5 mL of bone marrow
3. The marrow needle is removed, and pressure is
applied to the aspiration site with gauze until any
bleeding has stopped
BONE MARROW BIOPSY

Any of several needle models can be utilized;

however, the Jamshidi needle is considered the
most popular.
Patient preparation is carried out in the
manner previously described for bone marrow
aspiration.
1. The needle, with stylet locked in place, is held
within the palm and index finger and repositioned so
that a new insertion site is created for biopsy
sampling. Once the needle touches the bone surface,
the stylet is removed.
2. Using alternating clockwise and counterclockwise
motion, advance the needle slowly for 2 mm to 10 mm
into the bone

3. Rotate the needle with three twists to the right and

then to the left without advancing; repeat once again,
then withdraw the needle using a rotary motion.

4. Using a sterile gauze pad, apply manual pressure

to the site until the bleeding stops.
5. Specimen is placed in formalin solution for histologic
processing

Adequate biopsy in children :

at least 0.5 cm of well-preserved bone marrow
REFERENCES
Able, O., Friedmann, J., MBChB FRCPC, Doyle, J. 2008. Performing
bone marrow aspiration and biopsy in children: Recommended
guidelines. Paediatr Child Health. 13(6): 499–501

Henry’s clinical Diagnosis and Management by Laboratory Methods,

23rd edition, pg 533

Medscape
THANK YOU