Bone marrow puncture

Puncture of the iliac crest

A bone marrow puncture is used to assess blood formation and to diagnose or diagnose the spread of diseases of the bone marrow and the hematopoietic system (e.g. leukemia , plasmacytoma , malignant lymphoma ), but also to clarify the question of whether the bone marrow of disseminated (scattered) metastases of solid tumors (such as Breast cancer or lung cancer ) is affected.

Indications

• Pancytopenia
• Anemia alone
• Granulocytopenia alone
• Thrombocytopenia alone
• suspicion of
  • Idiopathic thrombocytopenic purpura
  • Primary myelofibrosis
  • Polycythemia vera
  • Essential thrombocythemia
  • Chronic myeloid leukemia
  • Myeloproliferative neoplasia
  • Acute myeloid leukemia
  • Acute lymphoblastic leukemia
  • Bone marrow metastases
  • Monoclonal gammopathy
  • Lymphoma
  • typical B-cell non-Hodgkin lymphoma
  • Hodgkin lymphoma
• unexplained hypercalcemia
• unexplained increase in bone alkaline phosphatase
• unclear skeletal changes
• Hyperparathyroidism
• Paget's disease
• Osteomalacia
• renal osteopathy
• Gaucher's disease

execution

The puncture is performed after local anesthesia with the aid of a hollow needle with a stylet on the posterior iliac crest (iliac crest puncture ) on the posterior superior iliac spine , rarely on the sternum (sternal puncture) or on the anterior iliac crest. A distinction is made between aspiration ("bone marrow cytology ") and a punch ("bone marrow histology "). During aspiration , bone marrow is drawn in, which extracts blood and small parts of the bone marrow and fat marrow.

The four to five jerky aspirations of the bone marrow can each be accompanied by pain for several seconds. This short, stabbing pain disappears quickly and, in addition to local anesthesia, can be reduced in advance with suitable painkillers. This is followed by a compression bandage for about 20 minutes. Postoperatively, pain equivalent to a bruise is to be expected .

The majority of patients prefer sedation. Younger patients in particular also state that they feel substantial pain and are afraid of further punctures, which suggests a rethinking of pain management for bone marrow punctures.

Complications

In rare cases, the following complications can occur during a bone marrow aspiration:

• Bleeding and infection at the puncture site
• Injury and inflammation of neighboring organs and tissue structures

Investigations

The puncture is then smeared onto a slide for cytological assessment (this smear is called a bone marrow smear ). In addition to this microscopic examination, additional immunological , cytogenetic or molecular biological examinations are usually carried out on it.

Punctio sicca

If it is not possible to suck in bone marrow, then one speaks of punctio sicca ("dry puncture"). This can be the case with diseases that are associated with strong connective tissue remodeling of the bone marrow, e.g. B. in osteomyelofibrosis or hairy cell leukemia be the case.

Punch biopsy

Using the punch biopsy , a bone marrow cylinder is obtained at the same time for the histological and, if necessary, an immunohistological examination.

Individual evidence

1. ↑ Torsten Haferlach: Pocket Atlas of Hematology: Microscopic and Clinical Diagnostics for Practice . Georg Thieme Verlag, August 22, 2012, ISBN 978-3-13-159256-9 , pp. 33-39.
2. ↑ Medical Skills Checklist . Georg Thieme Verlag, April 24, 2013, ISBN 978-3-13-170321-7 , pp. 178-179.
3. ↑ Survey of bone marrow aspiration. Retrieved January 17, 2020 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !