Bone marrow trephine biopsy is a procedure for taking a sample of bone marrow and sending it to a laboratory for further histological examination. Bone marrow is taken if the patient has blood diseases. Trepanobiopsy has similar features to such an analysis as puncture, but the biopsy result is as informative and extended as possible.
Indications
Trepanobiopsy is performed if the patient has the following pathological conditions:
- to change in numbers blood cells erythrocytes and leukocytes;
- anemia, what is severe and not amenable to traditional treatment;
- increased sweating with unknown etiology;
- constantly elevated temperature body;
- frequent infectious and viral diseases
- any disease blood;
- Availability oncological neoplasms in the bone marrow.
Trepanobiopsy is mandatory for patients who have to undergo chemotherapy for the treatment of oncological neoplasms. At the end of the course of chemotherapy, a second biopsy is performed to determine whether such treatment has given a positive result.
Contraindications
Trepanobiopsy is an absolutely safe procedure with minimal contraindications. A bone marrow biopsy is not performed in the elderly, as they are difficult to tolerate any type of anesthesia and take a long time to recover.
It is necessary to postpone the procedure if the patient has infectious and viral diseases that occur in the acute stage. There are also relative contraindications, in the presence of which trepanobiopsy can be performed, but with extreme caution due to the high risk of complications.
Relative contraindications include: diabetes, the presence of a severe stage of heart failure.
Difficulty in performing a bone marrow biopsy may occur in obese patients when they are not able to lie on their stomach for 10-20 minutes.
Preparation
To avoid possible complications, 2-3 days before the trepanobiopsy, you must stop taking medicines that affect the degree of blood clotting. It is worth refraining from the use of antiperspirants and cosmetic preparations, including scented hygiene products.
In the morning before the scheduled trepanobiopsy, you can have a light breakfast, but at least 4 hours must pass between the meal and the procedure.
You can drink water, but in limited quantities. Half an hour before the bone marrow biopsy, the patient is given sedative drugs.
Preparation for a trepanobiopsy includes the passage of a general and detailed blood test and ultrasound.
How do they do
The patient is placed on a couch on his stomach or on his side, the procedure is allowed while sitting, but only if the doctor has extensive experience in trephine biopsy.
The skin puncture site is carefully treated with disinfectants, a local anesthetic is injected. After a few minutes, the doctor checks the degree of sensitivity skin, and if the anesthetic has begun to act, proceed directly to the trepanobiopsy.
With the help of a special thin and long needle, slowly, with rotational movements, it is introduced into the ilium. A few millimeters of bone marrow is removed for histological examination.
1-2 hours after the procedure, the patient does not need medical supervision and goes home. Do not wet the puncture site for 3 days.
Does it hurt
A trepanobiopsy is performed using local anesthesia. A bone marrow biopsy is not painful, but rather unpleasant.
The patient will experience pressure at the insertion site, discomfort may be felt in the groin and thighs. To reduce the intensity of discomfort after a biopsy, an ice pack is applied to the puncture site.
What diseases does it show
Trepanobiopsy of the bone marrow helps to identify the following diseases: Hodgkin's disease, lymphoma, retinoblastoma, neuroblastoma, Ewing's sarcoma.
Trepanobiopsy is used to diagnose diseases such as leukemia, the presence of metastases from oncological neoplasms, and Gaucher's disease.
Trepanobiopsy contributes to the accurate determination of foci of accumulation of cancer cells.
Decryption
If there are abnormalities in the number of certain blood elements in the bone marrow, which may be caused by blood diseases, the concentration of myelokaryocytes in the test sample will be significantly reduced.
For staging accurate diagnosis the data of the blood test and the decoding of the histological examination of the bone marrow obtained during the trephine biopsy are taken into account.
An increase in blood elements in the bone marrow indicates the presence of blood diseases, but if their concentration is significantly reduced, this may indicate autoimmune diseases, the development of a severe form of anemia.
Complications
There is no likelihood of complications with proper and thorough treatment of the puncture site on the skin with antiseptic preparations.
Trepanobiopsy is a safe diagnostic procedure, but theoretically it allows the patient to experience complications after it, such as infection, bleeding. The risks of infection are higher in patients with diseases and defects of the heart muscle, with the presence of osteoporosis.
Temporary complications after trepanobiopsy, which are present for several hours, disappear on their own and do not require treatment - a feeling of internal chills, fever, pain at the injection site of the needle.
Signs in which you should immediately consult a doctor are a rapid deterioration in the general condition, severe pain that cannot be stopped with painkillers, shortness of breath, nausea and vomiting, fever.
Advantages and disadvantages
Trepanobiopsy is a highly effective and most informative diagnostic procedure for detecting various diseases blood.
The advantage of the method is that it does not require serious and special preparation, contraindications to trepanobiopsy, unlike other methods, are minimal.
The likelihood of complications, in the absence of contraindications in the patient and the work of a qualified, experienced doctor, is practically absent.
As such, there is no rehabilitation period after a bone marrow trepanobiopsy, recommendations relate to abstinence for several days from taking a bath, visiting a solarium, baths and saunas.
The disadvantages of trepanobiopsy include a long waiting time for histological results, which takes from 1 to 2 weeks. Taking a bone marrow sample is accompanied by quite unpleasant sensations, and if the patient has a high pain threshold, for carrying out a trepanobiopsy it is necessary to use potent anesthetics of the local spectrum of action, after which the patient may experience a slight malaise.
The disadvantages of bone marrow trepanobiopsy include the rather high cost of the procedure, but the price is fully justified by the maximum information content and the ability to quickly make a diagnosis.
Trepanobiopsy is a type of puncture biopsy during which pieces of bone tissue or mammary gland are taken for histology.
The study allows you to study the structure of the biomaterial, the cellular composition, the ratio of tissues and the characteristics of the vessels. During the procedure, doctors adhere to three principles:
- maximum benefit,
- painlessness,
- security.
The study is carried out for a long time, so the technique is worked out to the smallest detail.
Trepanobiopsy of the bone marrow
The method is one of the most informative, since the extracted fragment retains its structure.
For manipulation, a special needle with a diameter of 2 mm is used. It has a shield, a mandrin, a handle. There is a small spiral at the end. Thanks to this contour, the needle cuts well bone tissue.
The puncture is done under local anesthesia. During the procedure, tissue up to 10 cm long is removed. Usually, bone marrow is taken at the border of the lower back and gluteal region, in a scallop ilium 2-3 cm posterior to the anterior superior spine.
The test itself takes a few minutes. After it, you can immediately go about your daily activities, so the study can be carried out on an outpatient basis.
Trepanobiopsy of the breast
Most often, the procedure is prescribed in the period before the surgical intervention. It allows you to detect the presence of cancer cells with a certainty of up to 96%.
A feature of trepanobiopsy is that it can have a therapeutic effect if there is a cyst at the site of formation. Then the contents are removed through the cannulas, and the walls of the cyst are cauterized.
The time of the study is about 20 minutes, while the results are ready no earlier than in a week.
The examination is performed under local anesthesia. A small incision is made in the chest area, above the formation. A spring-loaded needle is inserted through it, which is placed in a special apparatus.
The needle moves inside the tissues until it is formed. Then it is captured. There are no stitches after the procedure, as there are no scars. For control, all manipulations are carried out under the control of USS.
Indications
Conduct an analysis when a conventional biopsy does not give the desired result. Then trepanobiopsy is crucial for differential diagnosis.
It is used for:
- aplastic anemia,
- detection of metastases
- detection of focal lesions,
- Gaucher disease,
The indication for the study of the breast is the need to determine the type of complex cyst, the presence of spots on the radiograph, the need to assess proliferation. This method also helps to determine the dynamics of the growth of nodes in mastopathy.
Contraindications
You can not carry out the procedure if there is allergic reactions for anesthetic drugs.
Not carried out if:
- the tumor is not visible on ultrasound,
- there is a pronounced hemorrhagic syndrome,
- have an acute infectious disease.
Study preparation and timing
Before the manipulation, an X-ray examination or ultrasound is performed, tests for the level of platelets, APTT are taken. Before a trepanobiopsy, you need to refrain from eating for several hours.
If necessary, you can drink small amounts of water. Sedatives are given 30 minutes before the examination.
A few days before the diagnosis, it is recommended to stop taking medications that affect blood clotting. If the study is carried out on the mammary gland, then it is not recommended to use deodorizing compounds and other cosmetics that are applied to the armpit.
The procedure takes from 5 to 20 minutes. Histological analysis is carried out in a laboratory, so the results have to wait up to two weeks.
The biomaterial obtained during the examination is placed in a container with a fixing solution. It does not allow cells to change properties for a long time.
Possible deviations from the norm in the analysis
If there is oppression or abnormal functioning of the bone marrow, then a reduced number of myelokaryocytes may be detected.
The results are affected by radiation, antibiotics and gold preparations.
If the number of myelokaryocytes is increased, this indicates anemia, which occurs with a lack of B12 or with a large loss of blood.
Complications
As with any surgical procedure, the study can lead to complications. The most frequent are:
- infection,
- bleeding.
Most often they occur in patients with an infected biomaterial sampling site, cardiac dysfunction, and a high degree of osteoporosis.
Sometimes after the procedure, there is chills and fever, increased pain, fluid release at the puncture site. Be sure to immediately consult a doctor if vomiting, shortness of breath, pain in the chest.
Bone marrow puncture is the only source of reliable assessment of the state of stem cells in leukemia, hemoblastoses, and lymphomas. The procedure is invasive, but is necessary for accurate verification of the type and severity of blood cancer.
What is a bone marrow puncture - is it dangerous to health
Technically, it is not difficult to perform a puncture. The procedure is necessary to verify the diagnosis, assess the quality of treatment. Microscopic examination of the punctate makes it possible to determine the ratio of different elements, which is important for planning therapy tactics.
The essence of the procedure is the taking of material from the middle part of the sternum, thigh. To do this, a puncture is carried out with a special needle with a limiter, which excludes penetration to a great depth.
The sternal sterile needle enters perpendicular to the sternum. After penetration to a certain depth, the bone marrow punctate is aspirated in a volume of about 1 ml. When taking material from the thigh, the procedure is similar, except for a different approach.
After removing the needle, a patch is applied to the puncture site. The bone marrow punctate is sent to the laboratory for immediate examination, as there is an increased likelihood of blood cells clotting. The resulting excess blood is removed with filter paper.
When patients take corticosteroids for a long time, the tendency to osteoporotic bone changes increases. Sternal puncture in such a situation is carried out carefully.
As a rule, there are no complications after bone marrow puncture of the sternum. It is possible to bring an infection into the cavity only with a gross violation of safety precautions. There are no large vessels around the sternum, so heavy bleeding does not occur. The penetration of the needle into the chest cavity is impossible due to the presence of a stopper on the needle. Only equipment is not suitable for puncturing the sternum of children, so the sampling in newborns is carried out from calcaneus or upper thigh.
Trepanobiopsy
Classical trepanobiopsy of the bone marrow is used to analyze the bone marrow structure, to study the characteristics of blood cells. Morphological analysis of punctate is important for hemoblastoses, leukemias, lymphomas, and other types of blood cancer.
The human bone marrow consists of a solid and a liquid part. To remove it, aspiration is performed, which allows you to take right amount material, but such manipulation reduces the quality of diagnosis, since the bone marrow content is diluted with blood. Difficulties arise with access to large bones, but for these purposes, standardized interventions have been developed with the destruction of the external bone structure (trephine biopsy).
All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.
Bone marrow examination is an extremely important stage in the diagnosis of many hematological diseases, when neither peripheral blood analysis nor sternal puncture provided the necessary amount of information.
The procedure for taking bone marrow tissue is called a trepanobiopsy. The resulting material in the form of a column is examined under a microscope, which makes it possible to determine the cellular composition, the degree of maturity of the elements of all hematopoietic germs, the state of the stroma, which reflect the presence or absence of a specific disease.
The red bone marrow is the main organ that provides a person with mature blood cells, which, having entered the peripheral blood, perform a variety of functions - maintaining immunity, delivering oxygen to tissues, and stopping bleeding. In the bone marrow, cells of all stages of maturity are found, from the stem "ancestor" to full-fledged uniform elements.
A complex cycle of maturation of the cell mass is impossible without a stromal component - connective tissue fibers, fibroblasts, vessels that play a supporting role, provide trophism of the hematopoietic organ, and enable full-fledged cells to leave the place of their formation.
In young children, red bone marrow can be obtained from almost all bones, but with age it is replaced by fat, and in adults it is present in sufficient quantities only in large tubular bones - the femur, ilium, sternum, ribs. The most “convenient” for trepanobiopsy of the bone marrow in adults is the ilium, which is quite easy to “approach” and which is rich in hematopoietic organ.
Often, an assessment of only the peripheral part of the formed elements does not give a complete picture of the nature of hematopoietic disorders and their causes, so doctors go for a trepanobiopsy to obtain a sufficient amount of bone marrow along with cells and elements of the stroma, which are subjected to microscopic analysis after appropriate preparation and staining.
Trepanobiopsy of the bone marrow is carried out everywhere, does not present any difficulties for an experienced specialist, is well tolerated and does not harm the patient with a correct assessment of indications and contraindications for the study.
When is trepanobiopsy needed and when is it contraindicated?
Trepanobiopsy is widely used in the practice of hematologists as one of the main methods for diagnosing diseases of the hematopoietic tissue. It is shown with:
- Severe anemia not responding to standard treatment protocols;
- Suspicion of polycythemia, erythremia, when in the general analysis the number of red cells (erythrocytes) is growing rapidly;
- Change in the number of cells of the white germ of hematopoiesis in peripheral blood, suspicious of a tumor;
- The presence of symptoms of a hematological disease (fever, sweating, weight loss, recurrent infections, unexplained lymphadenopathy, etc.) with an inconclusive picture of peripheral blood;
- Conducting chemotherapy - before and after treatment to monitor its effectiveness;
- Diagnosis of storage diseases - hereditary syndromes with enzyme deficiency and impaired hematopoiesis;
- histiocytosis;
- Signs of an immunodeficiency state;
- stock malignant tumors with possible metastasis to the bone marrow;
- Decrease in the number of formed elements when it is impossible to diagnose by puncture of the sternum or aspiration biopsy iliac bone.
In addition, trepanobiopsy of the bone marrow is performed in the differential diagnosis of a primary tumor process in the hematopoietic tissue and a secondary lesion of the bone marrow in the pathology of the liver, kidneys, endocrine system, infections, cancer metastases of other localization, etc.
Obstacles to trepanobiopsy do not occur very often, they are considered relative, that is, with the appropriate preparation of the patient, the procedure can be carried out. Among contraindications:
- Elderly and senile age;
- The situation when the conclusion on the bone marrow will not affect the treatment regimen and will not prolong the life of the patient;
- Inflammatory, pustular processes, eczema in the area of the alleged skin puncture;
- Severe bleeding disorder (severe thrombocytopenia);
- Acute general infectious pathology (flu, for example) - until the moment of complete recovery;
- Severe concomitant pathology - decompensated heart failure, diabetes mellitus, not amenable to correction, liver and kidney failure;
- The inability to lay the subject on the stomach due to severe obesity or pathology of the spine (preferably trepanobiopsy in a sitting position);
- Allergy to local anesthetics;
- Unwillingness and refusal of the patient to conduct the study.
Benefits bone marrow trepanobiopsy ilium the relative simplicity of the study, its safety, painlessness and good tolerance with high information content. In addition, bone marrow sampling does not involve lengthy and complex preparation, can be performed on an outpatient basis, does not require expensive equipment, and therefore is available to every patient who needs it. Trepanobiopsy takes little time and does not limit life in the future, hospitalization is also not required.
Unlike puncture of the sternum, which also allows obtaining samples of hematopoietic cells, trepanobiopsy makes it possible to comprehensively examine the structure of the hematopoietic tissue, evaluate the ratio and number of its components, study the nature and changes in the stromal and vascular component, which is extremely important in the diagnosis of oncohematological pathology.
In fact, trepanobiopsy has no drawbacks. Of course, the subject will have to overcome his fears, cope with the excitement before the procedure, experience quite tolerable pain, but all this seems insignificant compared to the benefits that the study will bring.
Preparation for trepanobiopsy and its technique
Before the doctor sets the date for the trepanobiopsy, the patient will have to undergo some preparatory measures - to pass general analysis blood, make a coagulogram, undergo fluorography, ECG (according to indications), consult narrow specialists in the presence of concomitant diseases. You may need x-rays of the pelvic bones and spine, ultrasound of the pelvic organs, lymph nodes, etc.
The attending physician must be aware of all medications taken, especially anticoagulants and antiplatelet agents used constantly. Blood thinners are canceled 10-14 days before the procedure to avoid bleeding.
Since the trepanobiopsy requires local anesthesia, the doctor finds out if there are any allergies to local anesthetics, if there have been adverse effects or any reactions to the administration of anesthetics in the past.
In case of osteoporosis, previous surgeries or injuries pelvic bones and the spine, the doctor must be informed about this in order to change the place of the bone puncture if necessary or cancel it altogether due to the risk of complications.
In the morning, a few hours before the examination, it is recommended to have breakfast so that the feeling of hunger and faintness does not disturb during the manipulation, and the patient does not lose consciousness due to unreasonable refusal to eat. Drinking a lot of liquid before a puncture is not advised, as it is overfilled bladder may need to be emptied at the wrong time.
Emotionally labile patients, as well as those who are overly worried or afraid of the study, may be given sedatives half an hour before the puncture.
Before a trepanobiopsy, the patient must be informed about possible complications, purposes and course of the procedure, after which he gives his written consent to the study. On the appointed day, he comes to the clinic on his own, without prior hospitalization.
Trepanobiopsy technique
Trephine biopsy of the ilium can be performed with the patient lying on his stomach (preferred) or on his side. If such a position is impossible, the subject is seated.
Trepanobiopsy of the bone marrow is performed with a special needle with a mandrel and a limiter, which prevents excessive penetration into the bone tissue. The needle has a thread, with which it is, as it were, screwed into the bone tissue, cutting it out with a column. After the puncture, it enters the medullary canal, after which the required amount of tissue is aspirated, which is sent after the procedure for histological examination.
bone marrow trepanobiopsy technique
Trepanobiopsy of the ilium takes no more than half an hour and can be performed on an outpatient basis. Before the puncture, the patient is given local anesthesia, in rare cases - general anesthesia, which is more preferable in pediatric practice. If there is hair at the site of the intended puncture (in men), the hair is removed.
The patient is placed on the stomach, side, back or sits down, after which the puncture site is treated antiseptic, and an anesthetic is injected into the soft tissues and under the periosteum. After a few minutes, as the skin and subcutaneous layer are impregnated with anesthetic, the patient loses sensitivity, and the doctor gently inserts the needle, slightly pressing and rotating it.
puncture site
The puncture site is the iliac crest 2-3 cm backwards from the anterior-superior spine or posterior spine where the ilium is closest to the skin.
By pressing on the needle and simultaneously rotating it along the axis, the doctor pierces the bone, the needle is inserted to a depth of 3-4 cm, after which careful oscillatory movements to the side to separate the tissue in the trocar from the walls of the bone. With the same rotational movements, but in the opposite direction, the needle is removed, and the bone marrow is pushed out with the help of a mandrin.
A trephine biopsy is always done by a doctor, the nursing staff helps during the procedure, fills out the documentation, sterilizes the instruments, treats the patient's skin with antiseptics and applies sterile wipes after the manipulation.
When the required volume of tissue is collected, and 1-2 ml is enough for histology, the needle is removed, the bone marrow is sent to a container with formalin for fixation, the vial is labeled, the nurse fills out a referral for examination indicating the patient's passport data and diagnosis.
If a cytological examination of bone marrow tissue is planned, the doctor immediately after receiving the material applies it to clean glass slides, receiving smears. Before immunological and cytogenetic analyzes, hematopoietic tissue is placed in test tubes with anticoagulants.
The bone puncture site is covered with a sterile napkin, and the patient must be laid in such a way as to ensure that the puncture hole is pressed for 10-15 minutes. This reduces the risk of bleeding.
After tepanobiopsy, no hospitalization is required, and after an hour the patient can leave the clinic, if his illness does not require inpatient treatment. It is not recommended to wet the puncture site for 3 days, so it is better to postpone visiting the pool, taking baths until the puncture hole is completely healed.
In view of possible reactions on anesthetics, doctors do not advise after a trepanobiopsy to drive or rush to work that requires increased attention. It is better if relatives or friends help you get home, and after the procedure it will be more useful to rest.
Complications after trepanobiopsy of the ilium are rare, but their probability cannot be completely excluded. During manipulation, the needle may break or separate from the handle holding it. With insufficient experience of the surgeon or violation of the technique of manipulation, rules of asepsis and antisepsis, bleeding, purulent processes at the puncture site, damage during puncture of large vessels and nerve trunks may develop.
Allergic reactions to painkillers deserve special attention, so the doctor finds out in advance if there are or have been adverse effects from anesthesia before, and the operating room always has a set of necessary medicines to stop a severe allergic reaction.
Many patients are afraid that they will be hurt during a trepanobiopsy. In fact, the procedure is well tolerated, and local anesthetics make it comfortable and painless. Unpleasant sensations are possible only with a puncture of the skin and the introduction of an anesthetic, but they quickly disappear under the influence of the drug.
After a trepanobiopsy, a slight soreness in the iliac bone is possible, which passes on its own and does not disturb the habitual life of the subject. When severe pain there is a risk of injury to a large nerve, so the doctor should be aware of this consequence of the procedure.
Emotionally labile patients, overly sensitive and suspicious people can experience the whole range of autonomic reactions during trepanobiopsy - tachycardia, sweating, dizziness and even fainting. To prevent these phenomena, sedatives are indicated.
The results of a trepanobiopsy of the ilium can be ready at different times depending on the type of bone marrow examination. A patient can receive a cytological conclusion even on the day of the study, and a histological response will have to wait at least a week, or even more. In complex studies, in cases that are difficult to diagnose, if it is necessary to obtain an advisory opinion from specialized departments of oncomorphology, etc., waiting for a response can take up to a month.
Bone marrow punctate during histological analysis provides a large amount of information to establish the correct diagnosis. Counting the number of cells of different hematopoietic lineages may indicate bone marrow hyperplasia or hypo- and aplasia in severe tumors of the hematopoietic tissue, as well as due to ongoing chemotherapy.
Analysis of the stromal component makes it possible to establish the degree of myelofibrosis, that is, the proliferation of connective tissue, which is characteristic of many tumor lesions of the bone marrow. This indicator is also important for predicting the course of the disease and monitoring the effectiveness of its treatment.
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Trepanobiopsy - a technique for obtaining a sample of red bone marrow from the ilium of the pelvis for the purpose of diagnosing blood diseases.
Synonyms: taking the bone marrow of the ilium, trephine biopsy, biopsy of the red bone marrow.
Trepanobiopsy is
procedure for taking a small amount of red bone marrow from the posterior superior iliac crest, primarily for histological examination. Gives information about the ability of the bone marrow to produce blood cells.
Trepanobiosia is similar to sternal puncture, but gives more extended information about the bone marrow, since the sample is holistic - it contains both hematopoietic cells and stroma.
The name comes from the Greek trephine- tool for drilling bone, biopsy- lifelong tissue sampling for diagnostic purposes.
What is red bone marrow?
Bone marrow- This is a soft tissue in which the formation of blood cells - erythrocytes, leukocytes and platelets. It is located in the cavity of the bones.
The bone marrow is made up of stroma– networks of supporting cells and stem cells, which are either at rest or divide, giving life to new blood cells.
In children under 5 years of age, red bone marrow is located in all the bones of the body, but with age it moves to large tubular bones(femoral, tibia), flat (skull, sternum, ribs, pelvic bones) and some small bones (vertebrae). In the process of aging, the bone marrow is increasingly being replaced by yellow bone marrow, fatty tissue in which hematopoiesis does not occur.
Indications for trepanobiopsy
- changes in general blood test or leukocyte formula
- diagnosis of diseases of the hematopoietic system in the presence of symptoms - sweating, fever, weight loss, frequent infectious diseases, rash in oral cavity, swollen lymph nodes, etc.
- before the start of chemotherapy (for leukemia, lymphoma, neuroblastoma), after the end and to assess the success of treatment
- diagnosis of thesaurismoses - accumulation diseases, when an enzyme deficiency leads to the accumulation of a particular substance in the body
- diseases of the macrophage system - histiocytosis
- increase lymph node if it is impossible to study it and suspicion of lymphoma
- long-term elevated body temperature with reduced immunity
- detection of metastases of other tumors in the bone marrow
Benefits of trepanobiopsy
- informative
- available
- relatively easy to do
- does not require special training
Disadvantages of trepanobiopsy
The disadvantages of trepanobiopsy are associated with a greater (compared to sternal puncture) burden on the patient. But, at the same time, no other study can replace trepanobiopsy.
Contraindications for trepanobiopsy
Absolute contraindications(completely prohibitive indications) for trepanobiopsy No.
Relative contraindications
- older age - the procedure will bring moral suffering, and the benefit of the diagnosis is minimal (for example, myeloproliferative disease in a patient over 80 years old)
- the result of a trepanobiopsy will not affect the treatment and will not improve the quality of life
- inflammatory diseases of the skin at the site of a potential puncture
- thrombocytopenia - a decrease in the number of platelets in the blood
- severe concomitant diseases (severe heart failure, uncompensated diabetes mellitus and others)
- inability to lie on the stomach (severe obesity and diseases of the spine) - a trepanobiopsy can also be performed in a sitting position, which depends on the skills of the doctor
- inflammation of the skin or subcutaneous fat at the puncture site - change the biopsy site
- refusal by the patient (or authorized person)
Preparation for a trepanobiopsy
- a few days before the planned date, a general blood test is performed with leukocyte formula and blood clotting tests
- tell your doctor if you are allergic to medications(especially for local painkillers), about the medications taken (warfarin, acetylsalicylic acid and others) and about the presence of disorders in the blood coagulation system
- also indicate the presence of osteoporosis and surgical interventions or fractures in the pelvis and spine
On the morning of the procedure, you can eat a light breakfast.
Trepanobiopsy needle
The trepanobiopsy needle consists of a wide handle (body) with a needle and a stylet inserted into it, a graduated stylet, a cannula, and a cover for the pen. The doctor chooses the size of the needle according to the thickness of the subcutaneous fat in the patient.
The principle of trepanobiopsy
During a trepanobiopsy, a trepanation needle is inserted into the cavity of the iliac crest, where the bone marrow is located. A whole bone marrow sample (bar) is obtained, after which the bone marrow is aspirated to prepare smears on glass slides for examination under a microscope.
Complications of trepanobiopsy
They are extremely rare, depending on the observance of the rules for the preparation and care of the puncture site.
- local bleeding
- wound infection
- pain at the puncture site
- an allergic reaction to a disinfectant solution or local anesthetic
- general autonomic response nervous system- palpitations, low blood pressure, dizziness, loss of consciousness
- nerve or muscle injury
Performing a trepanobiopsy
The procedure lasts 15-30 minutes. In men, the puncture site, if necessary, shave. Previously, the patient takes a drug for pain relief and a sedative. Trepanobiopsy can also be performed under general anesthesia.
The patient undresses, lies down on stomach or side. In some cases, trepanobiopsy is performed in a sitting position, depending on the preference of the doctor and the physical ability of the patient.
The puncture site is determined, the skin is disinfected, and an anesthetic is injected into the subcutaneous tissue. After 3-4 minutes, check the sensitivity of the skin. A needle for trepanobiopsy with rotational, soft movements with moderate penetration into the iliac cavity.
A whole sample of bone marrow is taken, which is placed in a container with formalin. If necessary, aspirate about 1-2 ml of bone marrow into the syringe.
The needle is removed, the puncture site is disinfected again and covered with a sterile dressing.
Directly after biopsy the doctor applies the resulting bone marrow to the prepared defatted slide and makes smears on 5-10 slides (up to 30). For immunological and cytogenetic studies, the material is placed in test tubes with anticoagulants.
Trepanobiopsy is performed both on an outpatient basis and during hospitalization. The patient can go home 1 hour after the procedure. You can not drive a car, so it is better to come to the hospital accompanied by a relative or friend. It is forbidden to take a bath for 3 days and wet the place of trepanobiopsy.
The result can be obtained after 2 hours with extreme need, up to 1 month if the tubes or smears are examined in another medical institution.
Analysis of the material obtained during trepanobiopsy
Received bone marrow is examined under a microscope(histological examination, histology) to assess the degree of development of various lines of cellular elements of the blood and for differential counting of cells after special staining (myelogram). The aspirate is also evaluated under a microscope, but this is already a cytological study, since the tissue structure is broken.
Part of the material is placed in test tubes for a special study - histochemical analysis to determine the activity of enzymes or PAS-glycogen content, immunophenotyping(presence of CD antigens on the surface of white blood cells), cytogenetic research, cultivation.
Trepnobiopsy in children
Trepanobiopsy in children is mandatory in the diagnosis and treatment of the following diseases:
- Hodgkin's disease
- non-Hodgkin's lymphomas
- neuroblastoma
- Ewing's sarcoma
- rhabdomyosarcoma
- retinoblastoma in advanced stages
Sometimes a trepanobiopsy is performed from the anterior superior iliac crest or tibia, mainly under general anesthesia and monitoring of vital parameters.
Sizes of needles for trepanobiopsy in children - 8GA - 10 cm in adolescents, 11GA - 10 cm in children of preschool and school age, 13GA - 6 cm in infants.