3.1.1 Bone Marrow Examination
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
