Indications for a bone marrow examinaton:

• Myelodysplastic syndrome
• Myeloproliferative disorder
• Lymphoproliferative disorder
• Metastatic infiltration of the bone marrow
• Bone Marrow hypoplasia, anemias
• Miscallaneous

Bone Marrow Examination Methods:

• Sternal puncture: cytologic evaluation of bone marrow aspirate
• Trephine biopsy: histologic evaluation of a bone marrow core and cytologic evaluation of a bone marrow imprint.
• The material obtained by both sternal puncture and trephine biopsy may also be evaluated using other methods: imunoflowcytometry, cytogenetics, molecular genetics

Trephine biopsy sample collection:

• Sampling from the posterior superior iliac spine
• Sampling from the calcaneus  — in very small children
• The sampling is performed using a trephine needle. First, local anestesia is applied; then the needle itself enters the body through a small incision and is pushed into the bone using increasing pressure combined with slight rotary motion.

Reasons for performing a trephine biopsy: quantification of the infiltrate, monitoring of post-treatment changes and restaging (in case of a relapse).

Indications for performing a trephine biopsy in oncology: suspected metastatic cancer, staging, post-treatment monitoring.

Histological evaluation of the trephine biopsy core:

• Fixation in Lowi solution or formol, decalcification, paraffin wax processing
• standard staining using HE
• special staining — PAS, Gömöry, Perls, Van Gieson etc.
• immunohistochemistry
• electron microscopy
• molecular genetic evaluation