Bone marrow trephine biopsy

Abstract

Trephine biopsies of the bone marrow should be carried out, when clinically indicated, by trained individuals following a standard operating procedure. A bone marrow aspiration should be performed as part of the same procedure. For patient safety and convenience, biopsies are usually performed on the posterior iliac crest. The biopsy specimen should measure at least 1.6 cm and, if it does not, consideration should be given to repeating the procedure, possibly on the contralateral iliac crest. If bone marrow aspiration is found to be impossible, imprints from the biopsy specimen should be obtained. Otherwise, the specimen is placed immediately into fixative and after fixation is embedded in a resin or, more usually, decalcified and embedded in paraYn wax. Thin sections are cut and are stained, as a minimum, with haematoxylin and eosin and with a reticulin stain. A Giemsa stain is also desirable. A Perls' stain does not often give useful information and is not essential in every patient. The need for other histochemical or immunohistochemical stains is determined by the clinical circumstances and the preliminary findings. Trephine biopsy sections should be examined and reported in a systematic manner, assessment being made of the bones, the vessels and stroma, and the haemopoietic and any lymphoid or other tissue. Assessment should begin with a very low power objective, the entire section being examined. Further examination is then done with an intermediate and high power objective. Ideally, reporting of trephine biopsy sections should be done by an individual who is competent in both histopathology and haematology, and who is able to make an appropriate assessment of both the bone marrow aspirate and the trephine biopsy sections. When this is not possible, there should be close consultation between a haematologist and a histopathologist. The report should both describe the histological findings and give an interpretation of their importance. A signed or computer authorised report should be issued in a timely manner. If the report is a preliminary, this must be clearly stated. (J Clin Pathol 2001;54:737-742)

Morbidity and mortality of deep sedation in outpatient bone marrow biopsy

“…Bone marrow biopsy and aspiration (BMBA) is a commonly performed procedure indicated in the diagnosing and treatment of blood disorders and solid tumors [1,2]. For adults, the infiltration of local anesthesia at the biopsy site has been used as the principal form of analgesia for BMBA [3].…”

Evaluation of bone marrow in patients with pancytopenia

“…In case of suspected plasma cell myeloma BMB is strongly recommended. 19 However in a study of Charles et al, who compared 79 simultaneous marrow aspirates and trephine biopsies from multiple myeloma patients, suggested that particulate aspirates may be at least as sensitive as trephine biopsies for detecting myeloma. 20 Out of 102 cases of pancytopenia, 20% of BMA showed erythroid hyperplasia, however, after correlation with biopsy, it reduced to 16.6%.…”

“…1 Focal hyperplasia of erythroid or granulocytic cells at a similar stage of maturation may be observed in hot spot. 19,21 A correlation with BME, clinical parameters and other laboratory parameters are required to trace the cause of pancytopenia in these cases. A possible hypersplenism needs to be ruled out in addition to different haemolytic anemias in cases of marrow showing erythroid hyperplasia.…”

Retrieval of broken Bone Marrow Biopsy Needle: a Case Report

“…A Trephine Biopsy [4] easily carried out on the Posterior Superior Iliac Spine, with the patient lying in the lateral position and the hip& knees in flexion. Ilium just below the Anterior Superior Iliac Spine is an alternative site, with the patient Supine and the approach being perpendicular to the Ilium.…”