Bone Marrow Aspiration

Hi all! I won't be sharing about the usual routine things that I do in the laboratory. Instead, I'll be sharing about how to prepare the bone marrow slides as I had the chance to witness a bone marrow aspirate procedure!

First of all, after the lab has been informed about the appointment made, one of the medical technologists (usually the haematologist) will be sent over to the ward to prepare the bone marrow slides. The physician would perform the bone marrow puncture and biopsy using aseptic technique and this is the kit they use:

As for the procedures for bone marrow aspiration, I’ll let the pictures do most of the talking. If you’re interested to know more about it, click on this link: http://www.pathology.vcu.edu/education/lymph/How%20to%20Marrow.pdf

Preparation of bone marrow on slides

Bone Marrow examination is important in the study of haemopoietic disorders and may be the only way to make a correct diagnosis. Comprehensive bone marrow morphology requires the examination of the bone marrow particles, push preparations, trephine biopsy imprints, trephine biopsy and correlation with peripheral blood picture. Valid interpretation requires consistent preparation of these samples.

The reagents and equipments needed are 20 microscope slides, at least 2 good spreaders, gauze, plastic plates for isolation of bone marrow particles, glass marker pen, disposable transfer pipette, EDTA tubes and slides holder.

The steps involve are:
1) Obtaining Specimen
- Check patient's name ID
- Ask for EDTA blood for peripheral blood smears ( at least 2) before the bone marrow aspiration procedure
- Transfer aspirate (0.5 ml) into EDTA tube as quickly as possible. Mix gently but thoroughly. Recollect the specimen if there are no fragments.
- If trephine biopsy specimen is also taken, make imprints by gently rolling specimen (at least 1 cm) between 2 microscope slides. Make at least 3-4 imprint smears.

- Transfer biopsy specimen into a bottle of formalin.
- Label all smears and EDTA tubes wit patient's ID, accession number and date.

2) On return to laboratory
- Expel the aspirate onto a plastic plate. Hold the plate at an angle so that fluid will run down the plate leaving bone marrow particles isolated.
- Transfer suitable materials onto microscopic slides and make smears as quickly as possible. At least 12 slides are required. Make extra smears if the patient is a suspected case of leukemia.

- Label all specimens and smears
- Patient's original request form, slides holder containing 10 marrow slides and 2 blood smears, EDTA tube of excess marrow and EDTA blood are all placed into a dispatched box and acknowledgement slip to be sent to NUH haematology laboratory and dispatch trephine biopsy specimen to NUH histology department.

Bone marrow aspiration is a really painful process. Hence, the physician doing the procedure must be trained and skilful in it so that the patient does not need to go through unnecessary amount of puncture before the physician succeed. Furthermore, the medical technologist preparing the bone marrow slides must know the procedures and criteria well so as to be able to produce satisfactory slides for proper evaluation. This is to prevent the slides being rejected by NUH and patient undergoing a second bone marrow aspiration.

All pictures are taken from: Riley, R. S. (2009, October). An Illustrated Guide to Performing the Bone Marrow Aspiration and Biopsy. Richmond, Virginia, United States of America.

That’s all folks!

Michelle

TG02

0703478H