BONE MARROW EXAMINATION

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 BONE MARROW EXAMINATION



It is the only method of correctly diagnosing diseases of blood.

Sites of bone marrow aspiration:
The following sites are selected for bone marrow aspiration:

  • Sternum
  • Iliac crest and upper end of tibia in children.
Requirements:
  • A special bone marrow needle (salah or klima needle) along with stilette


  • Local anesthesia (Lignocaine)
  • 2 to 5 ml syringe
  • Glass slides
  • Absolute methanol
  • Formal ethanol
Procedure:
  • The site of puncture is usually sternum. Sterilize the selected site with soap water, iodine and finally with alcohol.
  • The Site is anesthetized locally using lignocaine.
  • Skin and subcutaneous tissues are punctured using sterilized bone biopsy and needly.
  • When needle reaches periosteum, guarded needle is pushed further about 5 mm. Now the needle is fixed tightly in position.
  • Now the needle is further pushed with boring motion into the cavity of bone.
  • The stilette is removed and well fitted 2-5 ml syringe is used
  • About 0.3 ml of bone marrow contents are sucked.
  • Punctured site is properly sealed.
Preparation of the film:
  • Film must be prepared from aspirated bone marrow material immediately.
  • Film may be fixed in methanol followed by staining with giemsa method.
  • Further film may be fixed in formal ethanol for other cytochemical staining  if required.



Examination of bone marrow smear:
  • Estimate of cellularity: One can say that smear is rich in cells or relatively a cellular. It is done on the ratio of fat spaces and hemopoietically active parenchyma (normal 1.2 to 1.1)
  • Detailed cellular structure and cell composition:
    • It is done by estimating differential count.
    • M:E ratio is also estimated (normally 1.5:1 to 3:1)
  • Hemosiderin in bone marrow:
    • It is done by Peris's  method to estimate hemosiderin
    • Iron stores are determined
    • Iron storeed are decreased in hemosiderosis and hemochromatosis.
Bone Marrow Biopsy:



It is indicated as:
  • Repeated failure to obtain material by aspiration.
  • Evaluation of cellularity in pancytopenia.
  • Dry tap but there is doubt of leukemia.



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