Bone Marrow Trephine biopsy

What sample is needed for a Bone Marrow Trephine biopsy?

• The bone marrow is aspirated, and a trephine bone biopsy is taken.

What are the indications for bone marrow biopsy?

Bone marrow aspiration and biopsy are advised in the following ways:

1. To confirm the megaloblastic anemia.
2. To confirm the diagnosis of Leukemia.
3. To confirm the diagnosis of multiple myeloma.
4. It is advised in bone marrow hypoplasia.
5. This can be done for the culture of the organism.
6. For the diagnosis of metastatic infiltrate.
7. To diagnose bone disorders, such as Paget’s disease and bone cancer.
8. Bone tumor-like osteoma can be diagnosed.
9. This can give an idea about osteomalacia or osteoporosis.
10. Metastatic cancer infiltrates from the lung, breast, prostate, or any other organ.
11. To differentiate benign lesions of the bone, such as a benign cyst.
12. To find the causative agent of osteomyelitis.
13. To diagnose chronic bone pain in a specific area.
14. To evaluate any abnormality seen on X-ray.

What are the precautions for bone biopsy?

1. Stop the blood-thinning medicines (aspirin, warfarin, etc.)
2. Avoid bone biopsy in pregnant women.
3. Stop all medication, even including herbal medicine, which may thin the blood.
4. Ask about any allergy to anesthetic drugs.

What are the complications of Bone Marrow Trephine biopsy?

1. Sometimes the needle may break into the bone.
2. Rarely is there a bone infection.
3. There may be local hemorrhage or bleeding.
4. There may be an injury to the nerve or blood vessels.

How will you perform bone biopsy?

1. This procedure is the same as Bone marrow aspiration; a Trephine biopsy is done to take bone tissue.

2. Local anesthesia is applied.
3. This gives more information about the abnormalities of bone marrow cellularity and is more helpful for diagnosing Aplastic marrow.
4. Adequate bone biopsy measures around one inch.
5. Before putting it into formalin, make touch preparation.
6. Put this biopsy into buffered formalin.
7. It needs fixation for 12 to 24 hours.

What tests are done on bone marrow and bone biopsy?

1. Bone marrow smears and touch preparation may be stained by the Wright-Giemsa stain.
2. A special stain, such as Prussian blue, is used for iron.
3. Paraffin sections are stained with hematoxylin-eosin, PAS stain, and a reticulin stain.
4. Can do immunochemistry and molecular diagnostics.
5. Flow cytometry was also performed.
6. Molecular genetics studies are done for:
   1. PCR for detection of viral DNA and RNA.
   2. Fluorescent in-situ hybridization (FISH).
   3. Detection of the chromosomal abnormalities.
7. Bone marrow/biopsy material may be used for culture.
8. Can do electron microscopy (E/M).
9. Can do tissue culture.

What is the interpretation of the Bone marrow?

• Myeloid, erythroid, megakaryocytes, and lymphoid series cells.
  

  Bone marrow cells’ maturation

What will you see in normal bone marrow?

1. Cellularity to fat ratio at birth = 100%.
   1. It declines ∼10% each decade.
   2. Young children = 9:1.
   3. Young adults = 2:1.
   4. Middle-aged = 1:1.
   5. In old people, it gradually decreases = 1:9.
2. Bone marrow stainable iron = It is seen in reticuloendothelial cells and normoblasts or sideroblasts.
3. Flow-cytometry = It will differentiate:
   1. T- lymphocytes and B-lymphocytes.
   2. Degree of maturation as pre-B or mature B-lymphocytes.
   3. Detects the presence of cytokines or other receptors.

• Please see more details in the Bone marrow examination.

What is the difference between bone marrow aspiration and trephine biopsy?

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