Bone marrow biopsy and bone marrow puncture. Biopsy results.

2.Why are bone marrow biopsies and spinal taps performed?

A bone marrow biopsy and puncture is performed to:

• Find the cause of changes in red blood cells, white blood cells, or platelets in patients with thrombocytopenia, anemia, or abnormal white blood cell counts.
• Identify blood disorders such as leukemia, anemia, or factors affecting the bone marrow (multiple myeloma or polycythemia).
• Make sure that Hodgkin lymphoma or another type of lymphoma has not spread to the bone marrow.
• Look for infections or tumors that may have spread to the bone marrow.
• Find the best treatment methods for bone marrow diseases.
• Collect bone marrow samples for medical procedures such as stem cell transplants or chromosomal analysis.

Preparation for the procedure

The procedure for taking BM is common in hematology. No special preparation of the patient for sternal puncture or trepanobiopsy is required.

Preparation for manipulation differs little from preparation for other minimally invasive procedures:

• the patient must be examined before the procedure (complete blood count, coagulogram);
• Anticoagulants and antiplatelet agents, as well as all other medications except vital ones, are canceled within a few days;
• the patient should not eat or drink for several hours (if the procedure is scheduled for the afternoon, the patient needs a light breakfast in the morning);
• 2 hours before the procedure, you need to empty your intestines, and immediately before it, you need to empty your bladder;
• if there is hair at the site of the future skin puncture, it is shaved off.

It is necessary to notify the doctor if the patient has any allergies, especially if it is an allergic reaction to local anesthetics.

On the day of biomaterial collection, the patient should not be prescribed other procedures or surgical interventions. If there is a strong feeling of fear, the patient should take sedatives half an hour before the procedure, which should be reported to the doctor. Sternal puncture and trepanobiopsy are not pleasant manipulations, but they are also difficult to classify as painful.

The puncture site of the skin and periosteum is treated with a local anesthetic, so pain is not felt in this place.

Immediately before the procedure, informed consent for the manipulation is taken from the patient: the course of its implementation, as well as possible complications after it, are explained to him. If the puncture is to be performed on minor children, informed consent is taken from their parents or other legal representatives.

3.How is a biopsy performed?

These procedures are performed by a hematologist, oncologist, internist, pathologist, or specially trained physician. In adults, a sample of bone marrow fluid is usually taken from the back of the pelvic bone. In rare cases, a fluid sample is taken from the chest or the front of the pelvic bone. In young children, samples are obtained from the front lower part of the lower leg, just below the knee. A bone marrow biopsy is taken only from the pelvic bone. The puncture is performed using a needle. A biopsy uses a special instrument that is screwed into the bone.

Taking biomaterial

To perform a myelogram, a red CM is required. A sample can be obtained by puncture of the sternum (sternal puncture), biopsy of the ilium (trephine biopsy), calcaneus, femur or tibia.

The first two procedures for taking a sample of biomaterial in hematology are used most often. Trephine biopsy allows you to obtain a large volume of biomaterial for research. Taking bone marrow samples from the heel and other leg bones is used in newborns and young children.

4. Bone marrow biopsy results

Bone marrow biopsy results are usually ready within a week.

The following indicators are considered the norm:

• Bone marrow has normal amounts of fat, connective tissue, and iron. Normal ratio of adult and growing bone marrow cells.
• There are no signs of infection.
• There are no cancer cells such as leukemia, lymphoma or multiple myeloma.
• There is no spread of cancer cells from other affected areas.

Deviation from the norm:

• Bone marrow cells with pathology.
• The ratio of the number of different cells is disturbed.
• Bone tissue with pathology.
• Too much iron or too little iron (iron deficiency anemia).
• There are signs of infection.
• Cancer cells (leukemia, lymphoma, or multiple myeloma) are present.
• The bone marrow is replaced by scar tissue.

Depending on the results of a bone marrow biopsy or spinal tap, the doctor may prescribe additional examinations, select or adjust a treatment regimen, or, conversely, make sure that everything is in order with your health.

Study of cerebrospinal fluid. Lumbar puncture

The study of cerebrospinal fluid is one of the most reliable methods for laboratory diagnosis of inflammatory and autoimmune diseases of the nervous system. In order to accurately determine the feasibility of the study and protect you from undesirable consequences, we perform a cerebrospinal fluid study only as prescribed by a doctor at our clinic after appropriate preparation. We perform lumbar puncture on an outpatient basis if there are no contraindications to the puncture. After the puncture, we will leave you in the room under the supervision of medical staff for several hours (usually about 5).

To perform the puncture we will need:

1. MRI of the brain (not only the conclusion, but also images on films or disks), no more than 3 months old. This is important for your safety: for some diseases and congenital brain abnormalities, a lumbar puncture is too risky. If the pictures are unclear, we reserve the right to ask you to redo them.
2. Examination by a neurologist in our clinic. The doctor who will perform the puncture must accurately understand the indications for the study, the level of safety of the puncture in your case, and ways to prevent side effects.

We perform lumbar puncture with a disposable puncture needle, in a small operating room, according to all the rules of asepsis and antisepsis.

CSF examination, lumbar puncture. At an appointment with a neurologist at the Echinacea clinic

CSF studies, depending on the purpose of the study, may include:

• A study of cerebrospinal fluid to confirm or exclude the diagnosis of Multiple Sclerosis - a study of oligoclonal IgG in the cerebrospinal fluid.
• General analysis of cerebrospinal fluid: protein, glucose, cytosis (number and composition of cells), potassium, sodium, chlorine.
• Microscopy of cerebrospinal fluid for fungi, bacteria, atypical cells.
• Bacteriological culture of cerebrospinal fluid.
• PCR – study of cerebrospinal fluid biomaterial for tuberculosis, syphilis, toxoplasmosis, enteroviruses (poliomyelitis virus is part of this group of viruses), cytomegalovirus, herpes virus type 6, herpes simplex virus (types 1 and 2), Epstein-Barr virus, listeria, borrelia, chlamydia trachomatis, tick-borne encephalitis virus and some other infections.

Basically, a routine study of cerebrospinal fluid is required for the diagnosis and differential diagnosis of inflammatory diseases, incl. infectious and autoimmune diseases of the nervous system:

• Multiple sclerosis and multiple encephalomyelitis
• Chronic neuroinfections, incl. neuroborreliosis, neurosyphilis, central nervous system tuberculosis, herpetic infections, fungal infections
• Differential diagnosis of amyotrophic lateral sclerosis and slow neuroinfections
• Neurosarcoidosis
• Neuroleukemia

A common normal complication is post-puncture headache, this is normal and can last up to 1 week. If you experience a headache, you can contact your doctor and get the necessary advice.

Indications for use

1. Suspicion of bone marrow damage due to oncohematological diseases.2. Differential diagnosis of malignant oncopathology of the hematopoietic system and other diseases 3. Determination of the morphological type, prevalence, stage of the disease, which allows choosing a further examination plan for the patient, choosing management and treatment tactics, and predicting the course of the disease. 4. Monitoring effectiveness during and after treatment. 5. Determination of the disease state at the stage of monitoring the patient during the period of remission, confirmation of remission 6. Persistent anemia, cytopenia, cytosis, acceleration of ESR. 7. Neoplastic bone lesions.

Cytological and histological examination

Bone marrow smears are prepared immediately after puncture collection. The biopsy specimen for histological examination is preserved in special solutions. In the laboratory, histological sections are prepared from the biopsy material, stained and evaluated. At the same time, they try to prepare as many CM microslides as possible, especially in hypoplastic processes, when the samples taken are very poor in cellular elements. Cytological examination is carried out on the day of sample collection; histology requires up to 10 days.

During a cytological examination, myelograms are assessed:

• number and ratio of different types of cells;
• pathological changes in the shape, size and structure of cellular elements;
• type of hematopoiesis;
• cytosis;
• bone marrow indices;
• the presence of specific cells.

The result of a cytological study has the form of a table of three columns: the first contains the names of cellular elements, the second - the indicators determined in the BM samples, the third - the reference (normal) quantitative or percentage indicators.

Recovery after manipulation

The procedure itself lasts no more than 15 minutes. After taking the samples, the patient is under medical supervision for an hour: pulse, blood pressure, and temperature are monitored. If no complications are found within an hour, the patient is sent home. For pain, patients can take painkillers.

Since dizziness and fainting are possible after the procedure, examined patients are prohibited from driving on this day. The risk of bleeding from the skin puncture site is the reason for the prohibition from performing heavy work, playing sports or drinking alcoholic beverages for several days after the procedure.

To prevent infection of the skin puncture site, it is necessary to promptly change napkins and treat the wound with antiseptics. Until the wound heals, it is prohibited to visit public pools, saunas, or swim in the river.

Possible complications

Taking a bone marrow biopsy is considered a safe procedure. If it is performed by an experienced doctor and in compliance with all the rules, complications after it are very rare. These rare consequences include:

• infection of the puncture site;
• bleeding;
• through puncture or fracture of the sternum;
• fainting and shock in hysterical patients.

To avoid possible consequences, the doctor must strictly follow all stages of the procedure, and before it, conduct a confidential conversation with the patient.