18/05/2026
➡ Bone Marrow Procedure (Bone Marrow Aspiration & Biopsy)
➡ Bone marrow procedures are done to evaluate hematologic diseases such as leukemia, lymphoma, aplastic anemia, myeloproliferative disorders, plasma cell disorders, metastatic tumors, infections, and storage diseases.
➡ Common Procedures
Bone marrow aspiration → liquid marrow sample
Bone marrow trephine biopsy → core tissue sample
➡ Common Sites Adults
Posterior superior iliac spine (most common)
Anterior iliac crest
Sternum (aspiration only, NOT biopsy) Children
Tibia (infants) Iliac crest
Instruments Jamshidi needle (trephine biopsy)
Salah aspiration needle Syringes (10–20 mL)
Scalpel blade Local anesthetic (lidocaine)
➡ Slides and specimen containers
🔹 Jamshidi Needle
🚼 Indications
Unexplained anemia
Pancytopenia
Leukemia
Lymphoma staging
Plasma cell myeloma
Fever of unknown origin
Suspected metastatic tumor
Storage disorders
Contraindications
Relative
Severe bleeding disorder
Local skin infection
Severe thrombocytopenia
Anticoagulant therapy
➡ Bone Marrow Aspiration Procedure
Steps
Explain procedure and obtain consent
Position patient
Usually prone or lateral decubitus
Clean skin with antiseptic
Drape sterile field
Infiltrate local anesthesia
Insert aspiration needle into cortex with twisting motion
➡ Remove stylet
Attach syringe and aspirate marrow
Prepare smears immediately
Apply pressure dressing
➡ Aspiration Site
Bone Marrow Trephine Biopsy Procedure
Steps
Use Jamshidi needle
Insert needle with rotational pressure
Advance into marrow cavity
Rotate needle to cut core
Withdraw needle carefully
Remove biopsy core
Place specimen in formalin
Ideal Core Length
Approximately 1.5–2 cm
Complications
Pain
Bleeding
Infection
Dry tap
Rare injury to nearby structures
Dry Tap Causes
Myelofibrosis
Hairy cell leukemia
Packed marrow
Aplastic anemia
Metastatic carcinoma
➡ Bone Marrow Biopsy Histology
Important Stains
Wright-Giemsa stain
Reticulin stain
Iron stain (Perls Prussian blue)
Immunohistochemistry
Flow cytometry
➡ Clinical Uses
Diagnose leukemia
Evaluate marrow cellularity
Detect fibrosis
Assess metastatic disease
Monitor treatment response
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