Skills Laboratory: How to collect diagnostic bone marrow samples - Veterinary Medicine
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Skills Laboratory: How to collect diagnostic bone marrow samples
Bone marrow evaluation can help reveal the cause of abnormal blood work results and much more. Get good samples by following these steps for bone marrow aspiration and core biopsy.


VETERINARY MEDICINE



Figure 12B. After the needle is well-seated, vigorously rock it back and forth in two or three directions (red arrows) to cut the core and retain it within the biopsy instrument. Then withdraw the needle with a rapid twisting motion.
Remaining perpendicular to the cortex, insert the needle in the same manner as for the aspiration, but remove the stylet once the needle has purchase in the cortex (Figure 12A). After removing the stylet, continue to advance the needle into the marrow for about 1 cm, depending on patient size. After the needle is firmly seated, rock the needle vigorously and rapidly back and forth in two or three directions (Figure 12B). There will be little or no obvious lateral motion in the needle if it is securely seated. Then slightly retract, redirect, and slightly advance the needle to cut the core, which will be retained within the needle bore. Remove the biopsy needle from the bone with a continued twisting motion. Expel the core from the needle by placing the wire in the cutting end of the Jamshidi biopsy needle and gently pushing the small piece of cortical bone and marrow retrograde from the needle.


Figure 13. A gross specimen of a bone marrow core biopsy (unfixed). Note the white cortex (right) and red marrow (left). Shorter core samples (0.75 cm or more) are acceptable as long as sufficient red marrow is present. Marrow with decreased erythroid activity may be pale. The marrow tissue often appears gelatinous before formalin fixation.
If the biopsy is performed correctly, the sample will have a white end (cortex) and a red strip (marrow) (Figure 13). A core that is 0.75 to 1 cm long is sufficient. If the first attempt is unsuccessful, another attempt can be made adjacent to the first. Before placing the sample in 10% buffered formalin for submission to a surgical pathology service, you can gently roll it on a glass slide for cytologic samples if an adequate aspirate has not been obtained. Be careful not to crush the sample, resulting in a nondiagnostic biopsy sample.

CONCLUSION

This review is intended to provide the tools you need to become proficient in acquiring diagnostic bone marrow samples. Once confident in your skills, you may be surprised how often you will include this modality in your diagnostic work-up to provide high-quality care for your patients.

Kristen R. Friedrichs, DVM, DACVP
Karen M. Young, VMD, PhD
Department of Pathobiological Sciences
School of Veterinary Medicine
University of Wisconsin
Madison, WI 53706

REFERENCES

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5. Harvey JW. Canine bone marrow: normal hematopoiesis, biopsy techniques, and cell identification and evaluation. Compend Cont Educ Pract Vet 1984;6:909-927.

6. Lewis HB, Rebar AH. Bone marrow evaluation in veterinary practice. St Louis, Mo: Ralston Purina, 1979.

7. Relford RL. The steps in performing a bone marrow aspiration and core biopsy. Vet Med 1991;86:670-688.

8. Thrall MA, Weiser G, Jain N. Laboratory evaluation of bone marrow. In: Thrall MA, ed. Veterinary hematology and clinical chemistry. Baltimore, Md: Lippincott Williams & Wilkins, 2004;149-178.

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10. Wellman ML, Radin MJ. Bone marrow evaluation in dogs and cats. , Del: Gloyd Group Inc, Ralston Purina Clinical Handbook Series, 2000.


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