The cells in the blood and lymph system originate from stem cells in the bone marrow. A bone marrow examination is performed to diagnose lymphoma, leukemia, and metastasis to bone marrow. The examination usually includes an aspiration and/or biopsy from the iliac crest. When diagnosing Hodgkin's lymphoma, an aspirate and biopsy are taken from both sides. Sometimes, aspiration from the sternum is appropriate. In special cases, the aspiration is performed with the help of image guidance in cooperation with the nuclear medicine department.
A bone marrow examination involves:
- Smear for primary examination, otherwise for special indications
- Imprint of biopsy - the biopsy is placed on the slide glass and rolled out. This can be done if there are problems with the aspirate.
- Peripheral blood smear is taken if there is suspicion of leukemization (malignant cells in the blood circulation)
An expanded examination may include
- Flow cytometry immunphenotyping (marker testing)
- Cytogenetics (chromosome testing)
- Other molecular testing (For example PCR: polymerase chain reaction, FISH: fluorescence in situ hybridization)
- Special examinations associated with studies
The examination is usually performed under local anesthesia. General anesthesia is reserved for children and/or very anxious patients.
- To diagnose lymphoma patients
- Diagnosis of lymphoma infiltration of bone marrow
- Diagnosis of hematological diseases
- To check the effect of radiation/chemotherapy on bone marrow if there are problems with long-term cytopenia
- To diagnose metastatic tumors in bone marrow
- To diagnose or exclude disease involvement in the bone marrow
The only contraindication for carrying out a bone marrow biopsy is serious hemophilia. This must be performed in cooperation with a hemophilia clinic.
In case of warfarin treatment, the INR should be ≤ 3.
NSAIDs/ASA need not be discontinued. One should be aware of possible thrombocytopenia.