Bone Marrow Trephine biopsy (Bone biopsy) Part 2
Bone Marrow Trephine biopsy
The bone marrow is aspirated, and a trephine bone biopsy is taken.
Indications for bone marrow aspiration and biopsy:
Bone marrow aspiration and biopsy are advised in:
- To confirm the megaloblastic anemia.
- To confirm the diagnosis of Leukemia.
- To confirm the diagnosis of multiple myeloma.
- It is advised in bone marrow hypoplasia.
- This can be done for the culture of the organism.
- For the diagnosis of metastatic infiltrate.
Indication for the bone biopsy:
- To diagnose bone disorders like Paget’s disease and bone cancer.
- Bone tumor-like osteoma can be diagnosed.
- This can give an idea about osteomalacia or osteoporosis.
- Metastatic cancer infiltrates from the lung, breast or prostate, or any other organ.
- To differentiate benign lesions of the bone like a benign cyst.
- To find the causative agent of osteomyelitis.
- To diagnose chronic bone pain in a specific area.
- To evaluate any abnormality seen on X-ray.
Precautions for bone biopsy:
- Stop the blood-thinning medicines (aspirin, warfarin, etc)
- Avoid bone biopsy in pregnant women.
- Stop all medication, even including herbal medicine, which may thin the blood.
- Ask about any allergy to anesthetic drugs.
- Sometimes the needle may break in the bone.
- Rarely there may be a bone infection.
- There may be local hemorrhage or bleeding.
- There may be an injury to the nerve or blood vessels.
Procedure for bone biopsy
- This procedure is the same as Bone marrow aspiration; a Trephine biopsy is done to take bone tissue.
- Local anesthesia is applied.
- This gives more information about the abnormalities of bone marrow cellularity and is more helpful for diagnosing Aplastic marrow.
- Adequate bone biopsy measures around one inch.
- Before putting into formalin, make touch preparation.
- Put this biopsy into buffered formalin.
- It needs fixation for 12 to 24 hours.
Tests were usually done on bone marrow:
- Bone marrow smears and touch preparation may be stained by the Wright-Giemsa stain.
- A special stain like Prussian blue for iron is done.
- Paraffin sections are stained with hematoxylin-eosine, PAS stain, and stain for reticulin.
- Can do immunochemistry and molecular diagnostics.
- Flow cytometry was also performed.
- Molecular genetics studies are done for:
- PCR for detection of viral DNA and RNA.
- Fluorescent in-situ hybridization (FISH).
- Detection of the chromosomal abnormalities.
- Bone marrow/biopsy material may be used for culture.
- Can do electron microscopy (E/M).
- Can do tissue culture.
Bone marrow shows:
- Myeloid, erythroid, megakaryocytes, and lymphoid series cells.
Normal bone marrow:
- Cellularity to fat ratio at birth = 100%.
- It declines ∼10% each decade.
- Young children = 9:1.
- Young adults = 2:1.
- Middle-aged = 1:1.
- In old people gradually decreases = 1:9.
- Bone marrow stainable iron = It is seen in reticuloendothelial cells and normoblasts or sideroblasts.
- Flow-cytometry = It will differentiate:
- T- lymphocytes and B-lymphocytes.
- Degree of maturation as pre-B or mature B-lymphocytes.
- Detects the presence of cytokines or other receptors.
- Please see more details in the Bone marrow examination.
Difference between bone marrow aspiration and trephine biopsy:
|Feature||Bone marrow aspiration||Bone marrow trephine biopsy|
|Site||Posterior iliac crest, sternum.||Posterior iliac crest.|
|Indication||Anemia, pancytopenia, neutropenia, and thrombocytopenia a possible cause of leukemia and myeloma.||Polycythemia vera, myelofibrosis, myeloproliferative disorder, aplastic anemia, lymphomas, metastatic infiltrate, splenomegaly, PUO, and in case of a dry tap.|
|Information and purpose||
|Possible studies||Cytogenetics, culture, biochemical analysis, cytochemical marker, immunological studies, genetic abnormality studies by DNA, and RNA analysis.||Immunological studies and stains|
Prussian blue stain for iron.
Hematoxylin and eosin stain.