Bone marrow puncture is scary? Under what circumstances should this test be done?

Author: Shen Jun, Chief Technician of China-Japan Friendship Hospital

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

Many people find the term "bone marrow puncture" scary, but in fact, bone marrow puncture is a mature technology and an important test item for the diagnosis of blood system diseases. Through bone marrow cell morphology examination, we can understand the number and morphology of various blood cells in the bone marrow, as well as whether there are abnormal cells.

The best site for bone marrow puncture in adults is the ilium. Compared with the anterior superior iliac spine, the posterior superior iliac spine has a thinner bone cortex and a larger bone marrow cavity, so the probability of successful puncture is higher. There are no important organs around the posterior superior iliac spine, so the risk is lower. Therefore, the preferred site for bone marrow puncture is the bilateral posterior superior iliac spine.

Figure 1 Original copyright image, no permission to reprint

Bone marrow puncture is not as common as blood test. It can be performed when there is a high suspicion of blood system disease, such as unexplained abnormal peripheral blood cell count or blood component; unexplained fever, enlarged liver, spleen, and lymph nodes; unexplained bone pain, bone destruction, jaundice and purpura, etc. When the indications for bone marrow puncture are met, this examination can be performed. Secondly, this examination item is often used for regular examination and efficacy observation of blood system diseases.

Bone marrow puncture can also be used to examine infectious organisms, such as acid-fast staining to detect avian mycobacterium infection in HIV patients; bone marrow cell morphology to detect Leishmania donovani and histoplasmosis.

We can also detect tumors through bone marrow puncture. For example, some primary tumors metastasize to the bone marrow, such as lung cancer, breast cancer, gastric cancer, etc., which are very likely to metastasize to the bone marrow. Cancer cells appear to be adhered in clusters in the bone marrow smear, and sometimes cancer nests can be seen, and they may even occupy the bone marrow and destroy the normal bone marrow structure. At this time, other related examinations must be combined to determine the source of the tumor.

Figure 2 Original copyright image, no permission to reprint

In addition, bone marrow puncture can also be used to diagnose lipid deposition diseases, such as Gaucher disease and Niemann-Pick disease, which are autosomal recessive genetic diseases. Gaucher disease is caused by the lack of β-glucocerebrosidase in the body, which causes glucocerebroside to deposit in the mononuclear macrophage system. A large number of abnormal cells with rich cytoplasm and changes like onion skin can be found in bone marrow smears; Niemann-Pick disease is caused by the lack of sphingomyelinase, which makes sphingomyelin in the body unable to be metabolized, and it will also be deposited in mononuclear macrophages, showing "foam cells".

In short, bone marrow puncture is a common clinical examination technique, which has very important clinical value for the diagnosis of various blood system diseases and infectious diseases.