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7/28/2019 Teknik Bmp

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HARLINDA HAROEN

HEMATO-ONCOLOGY DIVISION

INTERNAL MEDICINE DEPARTMENTSAM RATULANGI UNIVERSITY

MANADO

THE BONE MARROW ASPIRATION & BIOPSI


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Bone Marrow (BM) is one of the most widelydistributed organs in the human body.

BMsoft fatty tissue found inside the bodyslarger bones.

It has a honeycomb/ sponge-like structure

consisting of a fibrous network that is filled with

liquid.


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Picture 1. Distribution of erythropoietic (red)

marrow in the normal adult


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The liquid contains stem cells, blood cells in

various stages of maturation iron, vit B-12 &folate for cell production.

BM its the principal site of blood formation

beginning at the time of birth all bone cavitiesfilled with hematopoietic tissue.

By adolescence, active marrow only found in thecavities of axial bones (sternum, ribs, vertebrae,clavicles, skull, pelvis & proximal ends femur &humeri.


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Overall BM cellurarity approximates 100% at

birthwith time (paralleling an age-associated

reduction in hematopoietic activity).

Accordingly BM cellularity in the N adult: 50% (remainder composed of adipose tissue).

Physiologic conditions, all sites of hematopoiesis uniform cellularity & cell lineage proportions.


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Thus, generalization evaluation of BM at single

site

In some hematologic disorders, study of BM at

multiple sites hasnt been shown to improve D/

accuracy.


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Exceptions: malignancy patchy marrow

involvement requiring larger specimens &

specimens from multiple sites

BMAB provides information about the status of

& capability for blood cell production


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BMAB usually regarded by the public &

physicians as a brutal, extremely & painful

procedure

As with any invasive procedure BMAB best

performed by trained clinicians.

With knowledge & experience:

succesfull marrow procedures minimal discomfort


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Bone Marrow Examination (BME) pathologic

analysis of samples of BM obtain by BMAB.

Peripheral blood examination & other routine

lab. assaysdont always provide enough

information for D/ hematologic disorders.

In some pts direct microscopic exam of the BM

confirmation of a suspected clinical D/ or

monitoring the course of medical Th/


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The decisions to subject a pts to BME after

critical assessment of pertinent informationavailable from history, physical & lab.

BME usefull tool in the D/ & staging of various

hematologic diss. & in the assessment of BM

cellularity, cellular morphology, & maturation.

Highly specialized testing cytogenetic,molecular analysis & immunophenotypic can be

performed on these specimens.


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To accommodate blood cell formation, BM also

houses of a stromal complex, along withelements of the monocyte-macrophage system

supporting cellular system number of

systemic diseases.

Accordingly BMAP & culture of BM have

value in the assessment of FUO & in D/ of

storage & infiltrative diseases


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INDICATION BONE MARROW EVALUATION

- Evaluation of unexplained anemia, leukopenia,

thrombocytopenia, or pancytopenia

- D/ & staging of lymphoma & solid tumor.

- Evaluation of peripheral counts ( eg, polycythemia)


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- D/ & evaluation of plasma cell disorders & leukemias

- Evaluation of iron metabolism & stores.

- Evaluation of suspected deposition & storage

diseases.- Evaluation of FUO, suspected mycobacterial, fungal,

or parasitic infections, or granulomatosis disease.

- Unexplained splenomegaly.


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- Evaluation of suspected chromosomal disorders in

neonates.

- Confirmation that the BM is N in a potential allogenic

hematopoietic cell donor.

- Marrow damage radiation, drugs, chemical &

myelotoxic agents.

- Determine the efficacy of Th/ & monitor recovery

process in BM transplantation/chemotherapy


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Figure 1. Clinical indication for a bone marrow evaluation


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CONTRA-INDICATION (CI)

CI absolute:- hemophilia, severe disseminated intravascular

coagulopathy, or other related severe bleeding

disorders.

CI relative:

Infection

Previous radiation at the same site

Poor cooporation

Sternal BMA dissease associated bone resorption

(multiple myeloma) risk sternal perforation


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CONTRA-INDICATION

Pts receiving anticoagulants:

PT/ aPTT within N the Th/ range for warfarin/

heparin.

Isolated thrombocytopenia isnt c.indication:

if the procedure properly performed

technical difficulties are not encountered

platelet transf. To insure platelet count > 20.000may be warranted.


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Complications from the BM is rare (0,12-0.30%) :- trauma to neighboring structures & soft

tissues

- infection- hemorrhage

- retroperitoneal hematomas

- fractures (osteoporosis)


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ASPIRATION & BIOPSY SITE

The posterior superior iliac crest & spine is the favoredsite.

The anterior iliac crest may used in adult when acces to

the posterior iliac crest is limited.

In selected cases greater trochanter of the femur,

individual vertebral bodies, or ribs.

BM maybe aspirated from the sternum (biopsy at this site

is CI) penetration sternum/ rib interspace fatal

hemorrhage.


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Dry Tap

Dry tap situation in which no BM sample is obtainable

by aspiration.

Faulty technique maybe the cause the tip of aspirating

needle may not have penetrated into marrow cavity.

More often myeloproliferative or leukemic disorder

such marrow changes usually involve an element offibrosis, metastatic tumor infiltration or granuloma.


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