Bone marrow biopsy (BMB) FAQs! Ever wondered what it's all about? Keep reading... π
What makes up a BMB? Usually it includes 2 samples - the aspirate (liquid marrow π©Έ) and the trephine (bone core π¦΄)
Why do we need 2 samples? The aspirate allows us to individually look at each BM cell under the microscope π¬ (e.g. WBCs, RBCs) and classify them via flow cytometry (a method of identifying and measuring pathological cells using their surface markers e.g. CD19 for B-cells)
The trephine lets us look at the way the BM is organised and assess for things like fibrosis and infiltration. We can also apply stains π (immunohistochemistry) to detect specific cells on the trephine
How is it done? It is a quick (20-30 min) awake procedure using local anaesthetic. It does not require a theatre and is often done at the patient bedside. It is done aseptically using 2 separate needles π (aspirate and trephine).
Where do you take the samples from? Most times we manage to get samples from the posterior iliac crest (on either side). If this is not possible (e.g. mobility issues), we can also access the anterior iliac crest. In rare cases, we may also consider accessing the sternum
Does it hurt? Highly variable! We always try to make it as comfortable as possible with local anaesthetic. Some find it painful, some uncomfortable, some don't feel it at all! For people who need frequent BMBs (e.g. patients w/ acute leukaemia), they often get "easier" over time.
Can you do it with low platelets or if the patient is on anticoagulants/antiplatelets? Yes. BMBs do not tend to cause significant bleeding, and usually this can be stopped with mechanical measures i.e. pressure
Are there any complications? BMB is a very safe procedure. Complications are usually limited to pain/discomfort, and a small risk of bleeding and infection. Damage to surrounding structures (e.g. nerves and blood vessels) is extremely rare.
How long do results take? β± An aspirate can be processed fairly quickly depending on urgency - sometimes within 24 hours. A trephine can take a bit longer (around 5 days) as it needs to be decalcified and then stained. Special stains (IHC) take longer.
In summary,Β BMB can be a really helpful test in specific situations and it's safe and generally well tolerated. Let us know if you have any questions - and next time your friendly haematologist is on your ward performing one, go along and see for yourself!π€ #FOAMed #blooducation
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