Bone marrow aspiration and trephine biopsy

Bone marrow aspirations and trephine biopsies are fundamental to the diagnostic investigation in myeloma as this provide histological confirmation of the diagnosis.

Bone marrow aspirate

Bone marrow aspiration is a simple reliable and rapid method of evaluating the bone marrow and the percentage of plasma cells present. It involves taking a sample of liquid bone marrow with a syringe and aspiration needle, usually from the iliac crest in the pelvic bone (see Figure 2). The sample is spread onto slides, stained and examined under a microscope, much like a blood film. This enables the size and shape (morphology), and the numbers of the different cells to be counted and examined. Aspirate samples can be further used for cytogenetic analysis and immunophenotyping, though the latter is not usually performed at diagnosis.

Bone marrow biopsy

A trephine biopsy provides more comprehensive information regarding the cellularity i.e. proportion of plasma cells, and the general structure and composition of the bone marrow. It is obtained with a special needle that removes a solid piece of bone marrow approximately 1 inch by one-sixteenth of an inch. The biopsy is processed in the histopathology laboratory where the samples are cut, stained and examined under a microscope. The morphological features of the individual cells, however, are best seen with an aspirate.

Nurses are increasingly the healthcare professionals performing bone marrow aspiration and biopsy procedures. These procedures can be distressing and uncomfortable for many patients, so it is essential that nurses are knowledgeable about appropriate analgesic and anxiolytic support. Pre-treatment options may include paracetamol, Entonox, or lorazepam to help manage pain and anxiety. In addition, nurses play a vital role in positioning patients to ensure maximum comfort and providing reassurance throughout the procedure, central to optimizing the patient experience and outcomes during these procedures.