What diseases require bone marrow puncture?

Bone marrow puncture is a means of examination and treatment. When some unexplained diseases occur, bone marrow puncture may be required. The most common ones are some unexplained anemia, or leukemia, and some myelomas, etc., may require bone marrow puncture examination. When performing a bone marrow puncture examination, you must understand some precautions and pay attention to them before and after the puncture.

What diseases require bone marrow puncture?

1. Anemia caused by various reasons and various types of leukemia, thrombocytopenic purpura, multiple myeloma, metastatic tumors, myelodysplastic syndrome, myelofibrosis, malignant histiocytosis, etc. 2. Certain parasitic diseases, such as malaria and kala-azar, can be treated by detecting parasites. 3. In case of long-term fever, enlarged liver, spleen and lymph nodes, bone marrow puncture can be performed to confirm the diagnosis. 4. Bone marrow puncture can also be used to observe the efficacy of treatment of certain diseases.

How to operate

1. Selection of puncture site: ① Anterior superior iliac spine: The puncture point is usually 1 to 2 cm above and behind the anterior superior iliac spine. The bone surface here is relatively flat, easy to fix, and the operation is convenient and safe; ② Posterior superior iliac spine: It is a bony protrusion located on both sides of the sacrum and above the buttocks; ③ Manubrium: It is rich in bone marrow. When puncture at the above sites fails, manubrium puncture can be performed, but the bone here is relatively thin, and there are atria and large blood vessels behind it. It is strictly necessary to prevent the danger of penetration, so it is rarely used; ④ Lumbar spinous process: It is located at the protrusion of the lumbar spinous process and is rarely used. 2. Body position: Supine during sternum and anterior superior iliac spine puncture. For the former, a pillow should be placed behind the back to make the chest protrude slightly. The posterior superior iliac spine should be punctured in the lateral decubitus position. Lumbar spinous process puncture is performed in a sitting or side-lying position.

3. Routinely disinfect the skin, wear sterile gloves, lay a sterile towel, and use 2% lidocaine for local infiltration anesthesia until the periosteum. 4. Fix the bone marrow puncture needle holder at an appropriate length (about 1.5cm for iliac puncture, it can be appropriately longer for obese people, and about 1.0cm for sternal manubrium puncture). Fix the skin of the puncture site with the thumb and index finger of the left hand, hold the needle with the right hand and insert it vertically into the bone surface (if it is sternal manubrium puncture, the puncture needle should be inserted obliquely at an angle of 30-40° to the bone surface). When the puncture needle touches the bone, rotate it left and right and slowly drill into the bone. When you feel the resistance disappear and the puncture needle has been fixed in the bone, it means that it has entered the bone marrow cavity. 5. Use a dry 20ml syringe to withdraw the inner plug by 1cm, pull out the needle core, connect the syringe, and slowly aspirate with appropriate force. A small amount of red bone marrow fluid can be seen entering the syringe. The amount of bone marrow fluid aspirated should be 0.1-0.2ml. Remove the syringe, push the bone marrow fluid onto the glass slide, and have an assistant quickly make 5-6 smears for cell morphology and cytochemistry staining examination. 6. If bone marrow culture is required, connect the syringe again, draw 2-3 ml of bone marrow fluid and inject it into the culture medium. 7. If bone marrow fluid cannot be extracted, it may be that the needle cavity is filled with skin, subcutaneous tissue or bone fragments, or the needle may be inserted too deep or too shallow, and the needle tip is not in the medullary cavity. At this time, the needle core should be reinserted, rotated slightly, or drilled in or out a little bit, and the needle core should be pulled out. If blood is seen on the needle core, bone marrow fluid may be obtained by aspiration again. 8. After aspiration, insert the needle core, slightly turn it to pull out the puncture needle, then cover the needle hole with sterilized gauze, press it slightly, and fix it with pressure tape.

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