Bone marrow aspiration (Bone marrow biopsy)

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• To obtain a bone marrow sample as an aid to diagnosis.

• Diagnosis of non-regenerative anemias , leukemias , any non-responsive cytopenia and pancytopenias.
• Adjunct to the staging of neoplasms such as lymphoma .

• Not a difficult procedure.
• Samples can be obtained from several sites: wing of ileum (described here), femur and the humeral head (best site for cats), or proximal tibia.

• One random sample could miss focal or multifocal disease.

• Faulty technique mainly to blame for failure to collect sample.
• Selection of site optimized by use of survey radiographs to identify areas of lysis.
• Must interpret results in conjunction with peripheral blood sample  taken at same time as marrow specimen.

• 15-30 minutes for sedation/anesthesia and skin preparation.

• 15-30 minutes.

• Anesthesia/sedation risk must be assessed in view of possible debilitated nature of patient.
• In many cases patient may be sick enough to require only minimal sedation for restraint

• Heavy sedation or anesthesia.
• If sedated, local anesthesia of collection site is necessary.

• Aspirate needle - plastic handle and guide with a bevelled stylet.

• Biopsy needle - 'Jamshidi' core needles.
• Glass slides.

• Syringe.

• 5 ml syringe.
• Formalin.

• Palpate the area over the dorsal surface of the ileum.
• Clip and prepare this site aseptically.
• Infiltrate skin, underlying musculature and periosteum of the dorsal surface of the ileum with local anesthetic.

• Sedated or anesthetized in sternal recumbency.

 It is often useful to follow the aspiration with a core biopsy.

• Make a stab incision through the skin over dorsal surface of ileum.
• Insert the aspiration needle vertically through the muscle layers until it reaches bone.
• Drive the needle into the bone with a to and fro coring motion.

• When the needle is firmly embedded in the bone, remove the stylet.
• Attach the syringe and apply sharp suction.
• A small amount of dark red marrow should well up into the syringe.

 Do not fill syringe beyond 0.5 ml mark. 

• Make multiple smears of this specimen immediately before it clots .
• Remove the aspiration needle.

Core biopsy

• Insert the Jamshidi needle through the same stab incision.
• Enter the bone at a different site from the needle aspirate, with a coring motion.
• When it is just below the periosteal surface remove the stylet.
• Push the needle into the bone to about 1cm with a to fro coring motion.
• Detach the core of bone by several twists.

• A good smear should have fat spaces and spicules of dense material .
• Air dry and send to lab.

Core biopsy

• Remove the needle carefully.
• Extract the bone core by pushing it from the tip of the needle toward the hub with wire.
• Fix the bone core in formalin and send to the lab for decalcification and analysis.
   Using feline serum smeared and dried as a 'footing' for cells, the bone core can be rolled gently between two glass slides before fixing in formalin, providing cytology specimens in addition to the histologic sections.

 Keep formalin in different room from marrow preparation as formalin fumes can actively deteriorate marrow preparation.

• Close wound using single skin suture.

• Broad spectrum antibiotic cover should be given in animals which are neutropenic.

• Occasionally bleeding/bruising may be significant in animals with severe thrombocytopenia or in cases with DIC.

• Failure to collect marrow is usually due to poor technique.
• Biopsy from an uninvolved site.

• Recent references from PubMed.
• Conner G H et al (1971) A technique for bone marrow biopsy in the cat. JAVMA 158 (10), 1702-1705.

• Professor B Feldman DVM PhD, Department of Biomedical Sciences and Pathobiology, Virginia Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24061-0442, USA.

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