Difference between bone marrow biopsy and bone marrow puncture

Bone marrow biopsy and bone marrow puncture are two different methods of examination and treatment. Bone marrow puncture uses a puncture needle to extract bone marrow fluid. This is a diagnostic technique called bone marrow puncture, while bone marrow biopsy uses this method to determine whether the red blood cell count is reduced. For some diseases, such as aplastic anemia, it has very important diagnostic significance in clinical practice. Let’s take a look at this aspect.

Difference between bone marrow biopsy and bone marrow puncture

Bone marrow puncture:

The bone marrow is hidden deep in the medullary cavity inside the bone. Bone marrow fluid can only be obtained through aspiration with a puncture needle. This diagnostic technique of extracting bone marrow fluid is called "bone marrow puncture."

Bone marrow puncture is widely used, most commonly for bone marrow examination. In addition, bone marrow puncture is required for obtaining bone marrow fluid for bacterial culture to diagnose typhoid fever or sepsis, bone marrow hematopoietic cell culture, and bone marrow transplantation.

The most common puncture site for bone marrow puncture is the ilium (i.e. pelvic bone). The patient can lie supine and obtain the sample from the anterior superior iliac spine, or lie prone and obtain the sample from the posterior superior iliac spine. If necessary, the sample can also be obtained from the protrusion of the sternum or spine.

The surgical procedure is to disinfect and lay a sterile surgical towel with a hole to expose the puncture site. After local anesthesia with about 1 to 2 ml of 2% procaine, use a special bone marrow puncture needle to draw 0.1 to 0.2 ml of bone marrow fluid by suction of the syringe, then pull out the puncture needle and cover it with a piece of sterile gauze to complete the operation. There may be a brief feeling of pain at the moment of extracting the bone marrow fluid, which is a signal that the puncture is successful. Apart from that, there will be no other pain. Except for hemophilia patients who lack coagulation factors and suffer from continuous bleeding, bone marrow puncture is prohibited. However, this operation generally has no contraindications.

Bone marrow biopsy

⑴ Correctly judge the degree of bone marrow hyperplasia and its cause in patients with hematopoiesis.

⑵ To determine the iron storage of bone marrow, especially when the iron storage is suspected to be reduced or iron deficiency occurs, bone marrow biopsy has more diagnostic value than bone marrow smear.

⑶ It has clear diagnostic significance for certain diseases (such as aplastic anemia, iron deficiency anemia and myelodysplastic syndrome) and the degree of bone marrow suppression after chemotherapy.

⑷ It can detect pathological changes that are difficult to detect through bone marrow puncture smear examination (such as myelofibrosis, bone marrow necrosis, colloid degeneration and granuloma, etc.), which is of great significance for the diagnosis of related diseases and the research on hematopoietic microenvironment and bone marrow transplantation.

⑸ It is of great significance in diagnosing, chemotherapeutic effects and determining prognosis of various acute and chronic leukemias and myelodysplastic syndromes. The positive rate for diagnosing bone marrow metastasis, malignant histiocytosis, Gaucher disease and Niemann-Pick disease is much higher than that of smear.

⑹ Can diagnose chronic myeloproliferative diseases, such as polycythemia vera, essential thrombocythemia, myelofibrosis, etc.

⑺ In order to clarify the cause of "dry tap", a bone marrow biopsy must be performed to explore whether it is caused by true bone marrow hypoplasia, bone marrow fibrous tissue hyperplasia, or extremely active cell proliferation in the medullary cavity leading to "dry tap".