Bone
marrow aspiration or biopsy is done to assess the cellularity
and morphology of the bone-marrow cells. They are probably
the most valuable diagnostic procedures for the diagnosis
and staging of haematological disorders. They can also be
used to assess the cause of bone-marrow failure in patients
with solid tumours as well as to investigate pyrexia of
unknown origin. Examination of the aspirate or biopsy specimen
may reveal infections, such as tuberculosis, Mycobacterium
avium-intracellulare (MAI) infections, histoplasmosis, leishmaniasis,
and other disseminated fungal infections. It may be useful
in establishing the diagnosis of storage diseases, such
as Niemann-Pick disease and Gaucher disease.
The
preferred sites for bone-marrow aspiration and bone-marrow
biopsy are:
1. Posterior iliac crest and anterior iliac crest (both
aspiration and biopsy)
2. Sternum (aspiration only in adults)
Proper
technique is required to obtain an adequate sample and a
suitable specimen for processing. Albeit extremely rare,
complications from bone-marrow aspiration and biopsy include
infection and bleeding. Even rarer complications include
iliac-bone perforation and haemorrhage, usually due to poor
technique and positioning of the patient.
Absolute
contraindications to bone-marrow aspiration or biopsy include
haemophilia and related coagulation disorders and infection
of the biopsy area. Neither thrombocytopenia or anaemia
is a contraindication.
Thin-spread
preparations of the aspirate or biopsy specimen on glass
slides are stained by Wright or Giemsa stains and subjected
to histopathological processing. Depending on the clinical
indications, other tests on the biopsy and aspiration samples
include flow cytometry, cytogenetics, fluorescence-in situ-hybridisation
(FISH) studies, and specialised cytochemistry. Prussian
blue stain may also be used to assess iron when disorders
of iron metabolism (for example, sideroblastic anaemias)
are suspected, whereas fungal, acid-fast bacilli, and bacterial
cultures are done when these infections are suspected in
patients with pyrexia of unknown origin.
Dr See
Hui Ti
Associate Consultant
Medical Oncology
