Diagnosis

Bone marrow aspiration

definition

A bone marrow puncture is an invasive procedure in which a tissue sample is taken from the bone marrow with the help of a special needle or punch. The sample is sucked through the needle either from the iliac crest or the sternum and contains cells of the blood-producing system and the immune system. It can then be examined using a microscope or assessed using an immunohistochemical analysis. Bone marrow puncture is often used to diagnose diseases such as leukemia or, more rarely, to treat diseases.

Indications for a bone marrow aspiration

The indications for performing a bone marrow puncture are very diverse. Most of the indications, however, are related to diseases of the blood-forming system or diseases of the cells of the immune system.

Furthermore, a distinction must be made as to whether a disease is already present and the puncture is used for further diagnostics or whether a disease is suspected and the puncture serves to clarify. A bone marrow puncture can also be used to monitor the progress of some diseases.

If a disease is to be confirmed and further clarified by a bone marrow puncture, there are usually too many or too few cells of the blood-forming system or of the immune system. This is for example Agranulocytosis or Granulocytopenia called. Also one Thrombocytosis or Thrombocytopenia may exist. This only affects a group of cells. If all cells in the bone marrow are affected, one speaks of one Pancytopenia.

In contrast, if leukemia is suspected, the disease is first diagnosed by a bone marrow aspiration. Above all, the cells of the immune system that can show structural changes should be considered. This concerns, for example, the diseases of chronic myeloid leukemia or the chronic lymphocytic leukemia. The acute form of the disease can also be recognized in this way.

Read more on the topic: How do you recognize leukemia?

Furthermore, if a lymphoma or a bone metastasis of a cancer focus is suspected, a bone marrow aspiration is performed.

The puncture is performed to monitor the progress of chronic anemia or leukemia.

Sometimes it also happens that stem cells are to be obtained through the procedure, which are important for the treatment of some other diseases. However, this case is rather rare.

A puncture is also performed if some other diseases are suspected, such as changes in bone structure, high calcium levels or an overactive thyroid. This is also rather rare.

preparation

The basis of a successful bone marrow puncture is the medical discussion at the beginning of the collaboration between the doctor and the patient. In this conversation, which usually takes place a few days before the bone marrow aspiration, the important points for the procedure are clarified. This also includes relevant previous illnesses such as a blood coagulation disorder, the use of certain medications such as blood thinners or substances harmful to the bone marrow, family conditions and allergies or intolerances.

You may need to stop taking some of the medication or make further preparations. A new appointment will then be made. Sobriety about eating and drinking is not necessary.

Procedure / implementation

If all problematic medication has been discontinued before the puncture, the normal puncture process can begin. For this, the person to be punctured is usually given a sedative and pain reliever beforehand. The sedative is intended to ensure that fewer problems arise from movement, fear or the like during the procedure. The pain reliever is intended to relieve the pain that occurs after the bone marrow aspiration.

All the materials required for the puncture are also laid out. Since the risk of infection is very high with a bone marrow aspiration, it is essential to ensure sterile working conditions. Special precautions are also taken for this.

A local anesthetic is then used. This anesthetic is given into the skin with the help of a syringe under sterile conditions. It should be placed around the entire area where the puncture will later take place so that there is no pain here during the puncture and removal of bone marrow.

Read more on the topic: Local anesthesia

Once the local anesthetic is effective, the puncture can begin, also under sterile conditions. To remove bone marrow from the iliac crest, the patient must lie down on the other side. With a puncture on the right, the patient lies on the left. In addition, the legs should be bent slightly. When bone marrow is removed from the sternum, the patient lies on his back.

The tip of the needle or punch is then pushed through the skin and the outer layer of bone until it reaches the bone marrow. Here several attempts are made to suck up the bone marrow. This can be painful, but is usually successful. The components such as cells, blood and fat are absorbed. This only takes a few minutes.

After the needle or punch has been removed, a light compression bandage is applied. In addition, you shouldn't move much for the next quarter of an hour. Overall, a day of rest shows good results. Both of these are intended to reduce postoperative pain, as this means that less blood gets into the tissue. A high degree of cleanliness should continue to be observed in order not to promote infection. The impairments disappeared completely within two weeks.

Read more on the topic: Pain therapy

The tissue sample is given to the laboratory or to the pathologist and assessed there under the microscope or immunohistochemically.

Do i need anesthesia? (0.25)

General anesthesia is not absolutely necessary for a bone marrow aspiration. However, this can occur in the case of great fears or some other indications. However, attempts are usually made to circumvent this, since general anesthesia is an immense burden on the body. In people who already have an immunodeficiency, this can be even more drastic.

Read more about: Risks of anesthesia

Instead of general anesthesia, an attempt is made to prevent the pain with the help of local anesthesia. For this purpose, an anesthetic is injected into the area of the later puncture with a syringe, which takes effect after a short time.

How painful is a bone marrow puncture?

A bone marrow puncture can be very painful for some people. However, this pain is short-lived and will not last any longer. Usually, however, the pain from a bone marrow puncture is mild to nonexistent. Because the administration of a sedative and a tablet to relieve the pain dampens the perception of the pain from the outset, the stress should not be too high.

Usually, the administration of the local anesthetic is described as slightly painful, as it is given into an unanesthetized area of the skin with the help of a syringe. However, the puncture is the step that causes the most pain. Due to this anesthesia, the further steps in the process are initially not perceptible. This means that even a possibly necessary small skin incision will not be noticed. Puncturing the bone with the needle or punch does not cause any pain either, since there are no pain receptors in the bone.

The greatest pain during bone marrow aspiration can now occur when the bone marrow is sucked in. Since it is picked up several times, it can be painful more often.

After the puncture has been performed and a compression bandage is in place, the anti-pain substances slowly decrease. Therefore, there is slight wound pain in the course.

Read more on the topic: Pain Management or Post-Operative Pain

Duration of pain

The duration of the pain caused by a bone marrow puncture is usually short-lived. In retrospect, however, more protracted pain can occur. The application of the local anesthetic is only painful for a short time. The most severe pain caused by sucking in the bone marrow can last for several seconds. These occur several times due to repeated suction, but also quickly subside. Post-bleeding or bleeding can also cause slight pain. It shouldn't last for more than two weeks and should go away as the bruise heals.

evaluation

The tissue sample from a bone marrow puncture is evaluated in the laboratory. To do this, part of the sample is spread on a slide. The cells of the bone marrow can be examined under the microscope for size, damage and other parameters. An immunohistochemical examination is also often carried out. Special features of the cells are marked with fluorescent substances. This can easily be viewed under a special microscope. This gives you very specific information that can provide information about diseases. A test for bacteria is less common.

How quickly do you get the result?

The time it takes to obtain a finding can vary. Depending on the question with which the bone marrow aspirate was sent to the laboratory or pathologist, a result may only be available within two days or up to four weeks.

Confirmation of leukemia, for example, can be made within a short period of time. No further steps apart from a microscopic examination are required for this. For some examinations, especially the immunohistochemical and cytological ones, a large number of cells is required. For this it may be necessary to specially prepare and multiply the cells beforehand. As a result, depending on the process, a few weeks can pass before a final result is achieved.

What complications can arise?

The removal of bone marrow as part of a bone marrow aspiration carries some risks. Some of these are common. However, these are not serious. The very invasive procedure with a needle or punch down to the bone injures some structures that are well supplied with blood. Because of this, bleeding into the tissue, bruises and secondary bleeding from the wound occur relatively often. These mainly occur when the compression bandage is not in place properly, is too easily fixed in place, or is removed too early. Too much movement after the puncture can also cause this. While this is slightly painful, it is not dangerous. The position is healed after two weeks at the latest.

Read more on the topic: Postoperative care or soft tissue injury

However, surrounding structures can also be damaged by the needle or the punch. For example, another organ or nerve can be damaged, which can have far-reaching consequences such as partial paralysis, reduced sensitivity or bleeding. However, the risk of this is low.

The most feared is an infection of the bone marrow following a bone marrow puncture. If left untreated, this can cause great damage and be fatal. This is especially the case if the affected person already shows damage to the immune system. An infection of the bone marrow detected early is also a serious disease and should not be underestimated.

Read more on the topic: Inflammation in the bone

Duration

The entire duration of a bone marrow puncture, including an informative discussion, preliminary examination and performing the puncture, can be a few days. If a detailed examination is also carried out by a laboratory, it can take a few weeks for the final results to be obtained.

However, if you only look at the duration of the procedure with preparation and subsequent rest phase, the procedure usually does not take much longer than an hour. The actual puncture does not even represent half the time. However, you should still not strain yourself on the day of the operation. The actual bone marrow puncture takes between ten and twenty minutes.

costs

The health insurance company covers the costs of a bone marrow puncture. A puncture of the bone marrow with a needle costs about 12 € regardless of whether it is performed in the iliac crest or in the sternum. In contrast, bone marrow puncture with a punch is a bit more expensive. This incurs costs of around € 17.5. In the case of privately insured persons, the doctor may charge a higher rate if necessary. In addition to these costs, there are additional costs for local anesthesia, a sedative and the subsequent evaluation in the laboratory or by the pathologist. This can increase the costs many times over.

How long will I be sick after that?

After performing a bone marrow puncture, one is usually not sick, but is considered healthy in terms of the puncture. Nevertheless, a light compression bandage should be worn for up to twenty minutes after the puncture in order to minimize the risk of bleeding. In addition, the body should be spared for 24 hours after the bone marrow aspiration and no strenuous physical work should be performed.

After taking a sedative pill, you may not actively participate in road traffic for 24 hours.

To prevent bone marrow infection, care must also be taken to keep the wound clean and not bathe for three days.

Usually a bone marrow puncture is carried out as part of another disease for clarification or further therapy planning, which is why the individual health status of course also depends heavily on it and must be assessed by the treating doctor in each individual case.