Bone marrow aspiration and biopsy from the iliac crest • Oncolex


The procedure starts by finding the correct level for the biopsy. The biopsies are taken from the upper iliac crest with access via the ventral spine. The midline of the spineous process is
identified, and the iliac crest is located by
palpation. When the correct point is found, the puncture point is marked using a straw. This is to avoid losing the marking
after washing. The area around the puncture point is washed with colored chlorhexidine. The procedure is carried out asepticly, but without sterile drapes. The area around the puncture point must
remain sterile during the whole procedure. Correct placement of local anasthesia is important for how the patient experiences the procedure. Ten milliliters of Xylocain, with 10 milligrams per milliliter of adrenaline is normally used. When the needle reaches the periosteum
the anesthesia is given time to work before the number area is expanded by
angling the needle in four directions. To avoid unnecessary trauma to the skin
from the aspiration needle, a small incision is made in the skin
with a scalpel blade. Disposable and reusable aspiration
needles are available. A reusable needle is used in this video. The needle is pushed toward the
posterior iliac spine and rotated with careful pressure until
it goes through the cortex. When the needle is in the spongy tissue
the trocar is removed, and a five milliliter syringe is connected
to the needle. .2 to 2 milliliters is quickly
aspirated for a regular bone marrow smear. Three small ad seven larger smears are placed on slides the slides are tilted and the blood
which collects in the lower edge of the smear is removed before it coagulates. We then use another slide to make a few regular smears, and some which are squeezed. The smears are dried with the fan before
fixation and staining. A new aspiration needle is used for aspiration for flow cytometry. .5 milliliters of Aminopyrin
is placed in the syringe in advance to stop the aspirate coagulating. 4 to 5 millilitres is aspirated with the
syringe The aspirate is quickly moved to a
specimen glass. Finally a punch biopsy is taken. A disposable needle is used. The needle is inserted in the same
puncture wound and pushed toward the posterior crest. The needle is rotated with constant
pressure until it penetrates the iliac crest. Care is taken to ensure that the needle
does not slide into an area that is not anesthetized. The trocar is removed from the needle the rotation of the needle is continued
until it has penetrated deep enough into the bone marrow. The spoon is inserted into the needle The biopsy needle is rotated, without
pressure, in both directions to cut the biopsy loose. The needle ,with spoon and biopsy, is
pulled out. The spoon is carefully removed from the needle and the biopsy is put in fixation fluid using a
blunt trocar. The incision is closed with strips and covered with an adhesive bandage.

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