Procedures (trephine biopsy, BM aspiration)

Question 1

Define trephine biopsy.

Answer 1

Biopsy of the bone marrow using a hollow needle

Question 2

What are the indications for trephine biopsy?

Answer 2

• Inadequate or failed aspirate.
• Need for accurate assessment of cellularity, whether increased or decreased.
• Suspected focal lesion (for example, suspected granulomatous disease or lymphoma).
• Suspected bone marrow fibrosis.
• Need to study bone marrow architecture.
• Need to study bone structure or bone marrow blood vessels.

Question 3

What are the complications of trephine biopsy?

Answer 3

Haemorrhage
Infection
Tumour seeding
Needle breakage
Lytic changes surrounded by sclerotic border
Persistent pain
Serous leak which persists

Question 4

Define bone marrow aspiration.

Answer 4

Removal of a BM sample using a needle

Question 5

What are the indications for BM evaluation e.g. asipration?

Answer 5

• Evaluation of unexplained anaemia, leukopaenia, thrombocytopaenia, pancytopaenia
• Unexplained elevations in peripheral blood counts e.g. polycythaemia, thrombocytosis, leukocytosis
• Diagnosis and staging of lymphoma or solid tumours
• Diagnosis and evaluation of plasma cell disorders and leukaemia
• Evaluate iron metabolism where routine lab testing is inadequate
• Evaluate suspected deposition and storage disorders
• Evaluate PUO
• Evaluate unexplained splenomegaly
• Confirmation of BM in a potential SCT donor

Question 6

What is a contraindication to BM biopsy?

Answer 6

Severe haemophilia

Question 7

What is the most common BM/aspiration site?

Answer 7

Posterior superior iliac crest and spine is the preferred site