Bone Marrow Aspiration and Biopsy in Critical Pediatric Patients: A Pathologist’s Perspective

Abstract

Bone marrow aspiration (BMA) and bone marrow biopsy (BMB), are medical modalities for the detection of non-malignant diseases as well as hematological malignancies in children. BMA attained momentum in the past few years owing to the possibility of achieving hematopoietic stem cells. Liquid bone marrow is aspirated through posterior/anterior iliac crest, tibia, and vertebral spinous process during BMA procedure in children for assessment of morphology at the microscopic level while BMB allows for cytological evaluation of marrow. It is also used for molecular genetics, immune-phenotypic, cytogenetics, and other specialized examinations. Additionally, BMA is also helpful in the reconstruction of tissue. These procedures should be performed by a specialist who has knowledge about the indication, contradictions, and hazards of these procedures due to their invasive nature. Still, there are no transparent guidelines available especially in the case of BMA for children. The purpose of this overview article is to focus on the specific guidelines to carry out the BMA and BMB in children and the techniques as well as complications associated with the BMA and BMB.

Bone marrow biopsies: A hospitalist bedside procedure service 5‐year experience

“…1 The acquired sample allows for the assessment of the morphology of cell lines as well as more specialized testing such as immunophenotyping, cellular genetics, and molecular testing. 1,2 While it is most frequently encountered as part of an outpatient workup for malignancy, acute conditions such as pancytopenia or other cell line abnormalities often require an inpatient BMAB. The clinical course of the patient may be dependent on bone marrow biopsy results and/or the patient may not be stable enough to discharge such that an outpatient biopsy would be able to be done in a timely manner.…”

“…It involves the insertion of a large‐bore needle into the bone with the extraction of the marrow using the aspiration technique with subsequent drilling (either with a power drill or manually) to obtain a core biopsy of the bone 1 . The acquired sample allows for the assessment of the morphology of cell lines as well as more specialized testing such as immunophenotyping, cellular genetics, and molecular testing 1,2 …”