Study of Bone - Marrow

The bone marrow is the site of active hematopoiesis after birth with the center of blood formation,The Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting.

After the age of seven years, the marrow is replaced slowly by the yellow fatty marrow.by  twenty years of age, active hematopoietic marrow is seen only in the sternum, ribs, clavicles, scapulae, vertebrae, cranial diploe, Flat bones of the pelvis & upper ends of the humerus & femur.

Cell Composition of Normal Adult Bone marrow

Cell Classification	Percentage of total cells (%)
Granulocytes
Myeloblasts	0.1 - 3.5 %
Pomyelocytes	05 - 5 %
Mylocytes	5 - 23 %
Metamyelocytes	7 - 27 %
Band forms	9 - 18 %
Segmented forms	4 - 28 %
Erythroid
Proerythroblasts	0.1 - 1.1 %
Basophilic	0.4 - 2.4 %
Polychromatophilic	2 - 30 %
Orthochromatic	2 - 10 %
Lymphocytes	5 - 24 %
Plasma cells	0 - 3.5 %
Monocytes	0 - 0.6 %
Macrophages	0 - 2 %
Megakaryocytes	0 - 0.5 %

Bone marrow Aspiration

The bone marrow aspiration is usually done first. The doctor makes a small incision, then inserts a hollow needle through the bone and into the bone marrow. Using a syringe attached to the needle, the doctor withdraws a sample of the liquid portion of the bone marrow. You may feel a brief sharp pain or stinging.

Site of bone marrow aspiration

1.       Anterior iliac crest.

2.       Posterior iliac crest.

3.       Sternum

4.       Tibia (in children <2 years)

5.       Lumbar vertebral spinous process.

Note :- 2 Cm below the anterior tibial i.e called tuberosity .

Indications

1.       Diagnostic

A.                  Anemia                                 - Iron Deficiency Anemia, Megaloblastic Anemia,

                                                                 Aplastic Anemia

B.                  Leukemias                          - Subtyping of acute leukemias

C.                  Multiple Myeloma           -

D.                  Infiltraative Disorders     - Storage diseases, granulomas, Metastatic disease

 

2.       Staging                                                        - Lymphomas, tumor.

3.       Follow up :

                                 i.            Leukemia

                               ii.            Aplastic Anemia

                             iii.            Agranulocytosid

4.       Therapeutic                                                - Bone marrow transplant

5.       Miscellaneous                                           - Unexplained anemia, leucopenia & thrombocytopenia

(Note : - Hemophilia & Congenital hemorrhagic disorders.)

Procedure

The patient lies in the left or right lateral position (iliac crest), the skin over the site is cleansed with antiseptic solution and draped. Alocal anaesthetic,The bone marrow aspirate needle (Klima or Salah).The stiletto is withdrawn and a 5 or 10 ml. Syringe is attached to the needle. Approximately 1 ml of the marrow is aspirated into the syringe with moderate suction.The syringe is then detached, the stiletto re-inserted and the needle is removed.

Advantage

Individual cells are well preserved and subtle morphological changes can be detected.

Disadvantage

         i.            Normal architecture of the marrowe is lost.

       ii.            Fibrosis of the marrow.

‘Dry tap’ is the inability to obtain marrow particles and may be due to:

         i.            Packed cellular marrow-leukemia, lymphoma

       ii.            Fibrosis

     iii.            Hypoplastic marrow

     iv.            Faulty technique

Bone Marrow Complications

Ø  Cardiac tamponade – injury to the great vessels

Ø  Infection at the site (osteomyelitis)

Ø  Hemorrhage

Ø  Bone pains

Ø  Hematoma

 

Function of bone marrow

 

Bone marrow is a spongy substance found in the center of the bones. It manufactures bone marrow stem cells and other substances, which in turn produce blood cells. Each type of blood cell made by the bone marrow has an important job. Red blood cells carry oxygen to tissues in the body.

 

Symptoms of bone marrow cancer

Ø  weakness and fatigue due to shortage of red blood cells (anemia)

Ø  bleeding and bruising due to low blood platelets (thrombocytopenia)

Ø  infections due to shortage of normal white blood cells (leukopenia)

Ø  extreme thirst.

Ø  frequent urination.

Ø  dehydration.

Ø  abdominal pain.

Ø  loss of appetite.

 

 

Can a human live without bone marrow ?

Without bone marrow, our bodies could not produce the white cells we need to fight infection, the red blood cells we need to carry oxygen, and the platelets we need to stop bleeding. ... In some cases, the best treatment is a transplant of bone marrow donated by another person

 

 

                                                                                               

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