Technique for performing trepanobiopsy of the ilium. Trepanobiopsy of the bone marrow - indications and contraindications, preparation

Bone marrow trephine biopsy is a procedure for taking a sample of bone marrow and sending it to a laboratory for further histological examination. Bone marrow is taken if the patient has blood diseases. Trepanobiopsy has similar features to such an analysis as puncture, but the biopsy result is as informative and extended as possible.

Indications

Trepanobiopsy is performed if the patient has the following pathological conditions:

to changes in the number of blood cells erythrocytes and leukocytes;
anemia, what is severe and not amenable to traditional treatment;
increased sweating with unknown etiology;
constantly elevated temperature body;
frequent infectious and viral diseases
any disease blood;
Availability oncological neoplasms in the bone marrow.

Trepanobiopsy is mandatory for patients who have to undergo chemotherapy for the treatment of oncological neoplasms. At the end of the course of chemotherapy, a second biopsy is performed to determine whether such treatment has given a positive result.

Contraindications

Trepanobiopsy is an absolutely safe procedure with minimal contraindications. A bone marrow biopsy is not performed in the elderly, as they are difficult to tolerate any type of anesthesia and take a long time to recover.

It is necessary to postpone the procedure if the patient has infectious and viral diseases that occur in the acute stage. There are also relative contraindications, in the presence of which trepanobiopsy can be performed, but with extreme caution due to the high risk of complications.

Relative contraindications include: diabetes, the presence of a severe stage of heart failure.

Difficulty in performing a bone marrow biopsy may occur in obese patients when they are not able to lie on their stomach for 10-20 minutes.

Training

To avoid possible complications, 2-3 days before the trepanobiopsy, it is necessary to stop taking medicines that affect the degree of blood clotting. It is worth refraining from the use of antiperspirants and cosmetic preparations, including scented hygiene products.

In the morning before the scheduled trepanobiopsy, you can have a light breakfast, but at least 4 hours must pass between the meal and the procedure.

You can drink water, but in limited quantities. Half an hour before the bone marrow biopsy, the patient is given sedative drugs.

Preparation for a trepanobiopsy includes the passage of a general and detailed blood test and ultrasound.

How do they do

The patient is placed on a couch on his stomach or on his side, the procedure is allowed while sitting, but only if the doctor has extensive experience in trephine biopsy.

The skin puncture site is carefully treated with disinfectants, a local anesthetic is injected. After a few minutes, the doctor checks the degree of sensitivity of the skin, and if the anesthetic has begun to act, proceed directly to the trepanobiopsy.

With the help of a special thin and long needle, slowly, with rotational movements, it is introduced into the ilium. A few millimeters of bone marrow is removed for histological examination.

1-2 hours after the procedure, the patient does not need medical supervision and goes home. Do not wet the puncture site for 3 days.

Does it hurt

A trepanobiopsy is performed using local anesthesia. A bone marrow biopsy is not painful, but rather unpleasant.

The patient will experience pressure at the insertion site, discomfort may be felt in the groin and thighs. To reduce the intensity of discomfort after a biopsy, an ice pack is applied to the puncture site.

What diseases does it show

Trepanobiopsy of the bone marrow helps to identify the following diseases: Hodgkin's disease, lymphoma, retinoblastoma, neuroblastoma, Ewing's sarcoma.

Trepanobiopsy is used to diagnose diseases such as leukemia, the presence of metastases from oncological neoplasms, and Gaucher's disease.

Trepanobiopsy contributes to the accurate determination of foci of accumulation of cancer cells.

Decryption

If there are abnormalities in the number of certain blood elements in the bone marrow, which may be caused by blood diseases, the concentration of myelokaryocytes in the test sample will be significantly reduced.

To make an accurate diagnosis, blood test data and a decoding of the histological examination of the bone marrow obtained during trepanobiopsy are taken into account.

An increase in blood elements in the bone marrow indicates the presence of blood diseases, but if their concentration is significantly reduced, this may indicate autoimmune diseases, the development of a severe form of anemia.

Complications

There is no likelihood of complications with proper and thorough treatment of the puncture site on the skin with antiseptic preparations.

Trepanobiopsy is safe diagnostic procedure, but theoretically allows the occurrence of such complications in the patient after it is carried out, such as the attachment of an infection, the opening of bleeding. The risks of infection are higher in patients with diseases and defects of the heart muscle, with the presence of osteoporosis.

Temporary complications after trepanobiopsy, which are present for several hours, disappear on their own and do not require treatment - a feeling of internal chills, fever, pain at the injection site of the needle.

Signs in which you need to immediately consult a doctor - a rapid deterioration in the general condition, strong pain, which cannot be stopped with painkillers, shortness of breath, nausea and vomiting, fever.

Pros and cons

Trepanobiopsy is a highly effective and most informative diagnostic procedure for detecting various diseases blood.

The advantage of the method is that it does not require serious and special preparation, contraindications to trepanobiopsy, unlike other methods, are minimal.

The likelihood of complications, in the absence of contraindications in the patient and the work of a qualified, experienced doctor, is practically absent.

As such, there is no rehabilitation period after a bone marrow trepanobiopsy, recommendations relate to abstinence for several days from taking a bath, visiting a solarium, baths and saunas.

The disadvantages of trepanobiopsy include long time waiting for histology results, which takes 1 to 2 weeks. Taking a bone marrow sample is accompanied by quite unpleasant sensations, and if the patient has a high pain threshold, trephine biopsy requires the use of potent local anesthetics, after which the patient may experience mild discomfort.

The disadvantages of bone marrow trepanobiopsy include the rather high cost of the procedure, but the price is fully justified by the maximum information content and the ability to quickly make a diagnosis.

Bone marrow trephine biopsy is one of the methods for obtaining a sample of red bone marrow to determine possible diseases blood.

A few introductory words about the procedure

During this procedure, it is possible to obtain a small amount of red bone marrow for histological studies. Such a liquid can provide extensive information about the possibilities spinal cord produce blood cells.

This procedure is very similar to a puncture, but its advantage lies in the possibility of obtaining more extensive and accurate information. Trepanobiopsy of the bone marrow allows you to take not only blood cells, but also the stroma.

What is bone marrow

Represents quite soft tissue in which blood cells are formed. These include leukocytes, platelets and erythrocytes. This type of brain is located in the cavity of the bones themselves.

The main component of the bone marrow is the stroma, which is a species. They can both be at rest and participate in the process of formation of new structures.

Please note that in young children, the bone marrow is located in almost all bones and only with age moves into the largest tubular and flat bones. As a result of aging, this organ is filled with a yellow substance that does not participate in the formation of new blood cells.

The main indications for the procedure

Trepanobiopsy of the bone marrow is not the most common procedure, but still quite popular. It is carried out in such cases:

general analysis blood showed significant changes;
the patient has a severe form of anemia that is not amenable to the usual methods of treatment;

an excessively large amount of hemoglobin and erythrocytes is noticed in the blood;
increased or, conversely, reduced blood levels of erythrocytes, leukocytes and platelets.

How to diagnose diseases associated with impaired blood functions

A procedure such as bone marrow trepanobiopsy can be prescribed if the patient has the following symptoms:

excessive sweating, persistent elevated body temperature, global weight loss or gain, frequent lesions infectious diseases, a significant increase in lymph nodes;
before chemotherapy, as well as after the end of this procedure;
a sharp increase or decrease in certain substances in the human body;
the patient has diseases - histiocytosis;
tumor formation in the bone marrow.

Benefits of the procedure

This technique is very informative, as it is able to read a large amount of information. Before it, you do not need to perform certain preparations, since it is quite simple to perform and has practically no restrictions for carrying out.

Contraindications

A procedure such as bone marrow trepanobiopsy, reviews of which you can read in this article, is considered absolutely safe, therefore it does not have strict contraindications for performing. However, there are some non-strict restrictions, in the presence of which the procedure should still be abandoned:

old age; in this case, trepanobiopsy will not show ideal results, and the patient will face long moral torments;
it should be borne in mind that the procedure itself will not affect the treatment in any way, and the quality of life will not improve;
you should not do the procedure if there is inflammation at the injection site;
with extreme caution should be taken to the presence of diseases such as diabetes and severe heart failure;
there is no way to lie on your stomach. For example, with obesity or various diseases of the spine. However, in this case, the injection can also be done while sitting, but only a very experienced, accomplished doctor can do this;
The patient may refuse to undergo the procedure for personal reasons.

Preparation for the procedure

Histological examination of "bone marrow trephine biopsy" still requires a little preparation for the procedure. To do this, you first need to pass a general blood test and check its coagulability.

Each patient should tell the doctor about allergies to certain drugs, as well as tell about the presence of diseases known to him. This will make it easier to transfer the anesthesia procedure.

Tell us about the presence of osteoporosis, as well as previous surgical interventions.

In the morning before the procedure, doctors advise you to eat a small and light breakfast.

How is a bone marrow biopsy performed?

The procedure itself takes no more than half an hour. If an injection is given to a man, then if there is a large amount of hair on the area being injected, the skin is shaved. After that, the patient is given painkillers and sedatives. If the patient wishes, the injection can also be done under general anesthesia.

The ideal position for the procedure is lying on your stomach or on your side. But it is possible to do this while sitting. It all depends on the patient and the experience of the doctor.

Now you need to find the optimal puncture site, disinfect the skin and inject an anesthetic. After a few minutes, the sensitivity of the skin is checked. If everything proceeds normally, then with the help of a special needle, they penetrate into the cavity of the ilium with very soft rotational movements.

During this procedure, a small amount of bone marrow (about one to two milliliters) is taken. After that, the needle is removed and the pierced area is disinfected.

Trepanobiopsy of the bone marrow (why they do it, you can read in this article) can be performed not only in the outpatient clinic, but also during hospitalization. Within an hour, the patient will be ready to go home. However, doctors strongly do not recommend driving a car yourself. It is best to come to the hospital with a relative or friend.

Please note that after this operation, you can not take a bath and wet the punctured area for at least three days. Usually, the results of the procedure can be found in a few hours. But if the material is examined elsewhere, this period may last up to a month.

Trepanobiopsy is a method of extracting a piece of bone marrow from a person without violating its integrity, in order to conduct a histological analysis.

Such a procedure allows the doctor to determine whether there are changes in the bone marrow and to identify a number of diseases: erythremia, leukemia, osteomyelosclerosis, and others.

In addition, this method allows you to extract a sufficient amount of material, which is impossible to do with a puncture. For puncture, special needles are usually used, they are also called trepans.

There are two types of trepanobiopsy: bone marrow and breast. In the first case, this procedure remains the most informative, since the fragment for analysis does not change its structure during sampling. The needle for the operation is small, only 2 mm.

To get to the iliac crest, where the material is taken from, a puncture is made.

The whole procedure takes several minutes. It is carried out under local anesthesia. There are no consequences after it, so there is no need to stay in medical institution after manipulation.

Trepanobiopsy of the mammary gland is the most accurate way to determine whether there is in the patient's body cancer cells or not. The accuracy of this method is over 90%.

If there is a cyst at the site of formation, from where the material for analysis is taken, then trepanobiopsy will help get rid of it. To do this, experts remove the fluid and cauterize the walls of the cyst.

The procedure takes no more than 20 minutes. The study is also carried out under local anesthesia using special spring needles. The most pleasant bonus from such manipulation is that there is no need for stitches. Scars after trepanobiopsy of the breast do not remain.

When should a trephine biopsy be performed?

Trepanobiopsy is not necessary in all cases of the disease. It is used to determine splenomegaly of unknown origin, chronic myeloproliferative diseases, aplastic anemia, bone marrow damage.

Doctors resort to this procedure when a conventional biopsy has failed.

As for contraindications, there are several of them:

the procedure should not be performed in patients with an allergy to anesthesia;
in a patient, a tumor is not detected by ultrasound;
the presence of acute infectious diseases;
poor blood clotting;
epilepsy;
diseases of the respiratory system.

The procedure for performing a trepanobiopsy

Before the procedure, the patient must pass the necessary tests and be sure to do it. The trepanobiopsy procedure is performed by a doctor. Prepares the instrument and the operating field. A puncture is made in the iliac crest. The needle is designed in such a way that, when rotated, it cuts out a column of bone and bone marrow tissue. This makes the procedure faster and safer for the patient.

After that, material is collected for research. Next, the instrument is removed, and the material for analysis is sent for study. Results are expected no earlier than two weeks later. Thanks to this method, it is possible to accurately determine the presence of serious diseases or abnormalities in a patient.

Complication after surgery

Any surgical intervention is always a risk. And do not forget about this, even when performing a trepanobiopsy. The most important indicator is the health of the patient. The most common complications after the procedure are bleeding and infection of the body.

After the operation, there may also be consequences:

Infection of the site of trepanobiopsy;
blood infections;
High level of osteoporosis;
Violation of the cardiovascular system.

In order to protect themselves, patients who take blood thinners at the time of the sampling are advised by doctors to stop taking them for a while. After a trephine biopsy, a person may experience complications such as chills, fever, soreness at the puncture site, bleeding or redness, nausea and vomiting, joint pain, fatigue, shortness of breath, chest pain, and cough.

In this case, you should immediately contact your doctor. Usually, all non-dangerous symptoms disappear on the second day after the procedure.

Postoperative period

In the event that the manipulations were carried out on the mammary gland, experts recommend not lifting weights for 2-3 days. Due to local anesthesia, patients do not experience pain, they are most likely uncomfortable and unpleasant during the procedure.

The study makes it possible to study the structure of the seized material, the composition of the cells and the characteristics of the vessels. When a doctor performs a trepanobiopsy, he is guided by the following principles: benefit, safety and painlessness.

Trepanobiopsy has been performed for many years. Therefore, you should not worry about the technique of manipulation. Thanks to the accumulated experience, it has been worked out to the smallest detail.

Indications

Trepanobiopsy is performed if the patient has the following pathological conditions:

to changes in the number of blood cells erythrocytes and leukocytes;
anemia, what is severe and not amenable to traditional treatment;
increased sweating with unknown etiology;
constantly elevated temperature body;
frequent infectious and viral diseases
any disease blood;
Availability oncological neoplasms in the bone marrow.

Contraindications

Relative contraindications include: diabetes mellitus, the presence of a severe stage of heart failure.

Difficulty in performing a bone marrow biopsy may occur in obese patients when they are not able to lie on their stomach for 10-20 minutes.

Training

To avoid possible complications, 2-3 days before the trepanobiopsy, it is necessary to stop taking medications that affect the degree of blood clotting. It is worth refraining from the use of antiperspirants and cosmetic preparations, including scented hygiene products.

In the morning before the scheduled trepanobiopsy, you can have a light breakfast, but at least 4 hours must pass between the meal and the procedure.

You can drink water, but in limited quantities. Half an hour before the bone marrow biopsy, the patient is given sedative drugs.

Preparation for a trepanobiopsy includes the passage of a general and detailed blood test and ultrasound.

How do they do

The patient is placed on a couch on his stomach or on his side, the procedure is allowed while sitting, but only if the doctor has extensive experience in trephine biopsy.

With the help of a special thin and long needle, slowly, with rotational movements, it is introduced into the ilium. A few millimeters of bone marrow is removed for histological examination.

1-2 hours after the procedure, the patient does not need medical supervision and goes home. Do not wet the puncture site for 3 days.

Does it hurt

A trepanobiopsy is performed using local anesthesia. A bone marrow biopsy is not painful, but rather unpleasant.

What diseases does it show

Trepanobiopsy of the bone marrow helps to identify the following diseases: Hodgkin's disease, lymphoma, retinoblastoma, neuroblastoma, Ewing's sarcoma.

Trepanobiopsy is used to diagnose diseases such as leukemia, the presence of metastases from oncological neoplasms, and Gaucher's disease.

Trepanobiopsy contributes to the accurate determination of foci of accumulation of cancer cells.

Decryption

To make an accurate diagnosis, blood test data and a decoding of the histological examination of the bone marrow obtained during trepanobiopsy are taken into account.

Complications

There is no likelihood of complications with proper and thorough treatment of the puncture site on the skin with antiseptic preparations.

Trepanobiopsy is a safe diagnostic procedure, but theoretically it allows the patient to experience complications after it, such as infection, bleeding. The risks of infection are higher in patients with diseases and defects of the heart muscle, with the presence of osteoporosis.

Signs in which you should immediately consult a doctor are a rapid deterioration in the general condition, severe pain that cannot be stopped with painkillers, shortness of breath, nausea and vomiting, fever.

Pros and cons

Trepanobiopsy is a highly effective and most informative diagnostic procedure for detecting various blood diseases.

The advantage of the method is that it does not require serious and special preparation, contraindications to trepanobiopsy, unlike other methods, are minimal.

The likelihood of complications, in the absence of contraindications in the patient and the work of a qualified, experienced doctor, is practically absent.

As such, there is no rehabilitation period after a bone marrow trepanobiopsy, recommendations relate to abstinence for several days from taking a bath, visiting a solarium, baths and saunas.

The disadvantages of trepanobiopsy include a long waiting time for histological results, which takes from 1 to 2 weeks. Taking a bone marrow sample is accompanied by quite unpleasant sensations, and if the patient has a high pain threshold, trephine biopsy requires the use of potent local anesthetics, after which the patient may experience mild discomfort.

A section of compact and spongy bone substance is removed along with the bone marrow. T. allows you to obtain information about the structure of bone tissue and the architectonics of the bone marrow (cellular composition, the ratio of hematopoietic and adipose tissue, the state of the stroma and blood vessels).

The indication for T. is of unclear etiology, when sternal puncture and ordinary iliac bone with a needle intended for aspiration biopsy (Biopsy) , do not provide information about the state of the bone marrow. In such cases, T. becomes crucial in differential diagnosis diseases of the blood system and diseases accompanied by secondary lesions of the bone marrow (for example, chronic infections, systemic diseases of the connective tissue, as well as endocrine disorders, diseases of the liver, kidneys, tumor metastases). T. in combination with other clinical and laboratory research methods are widely used in the diagnosis of hemoblastosis, especially acute leukemia, aplastic, osteomyelofibrosis, to detect metastases in malignant lymphomas and cancer, as well as other focal lesions of the bone marrow. The method is also used in the diagnosis of bone tumors, some lesions of the skeletal system, mainly with polyostotic localization. T. is carried out before the start of treatment, but in some cases, for example, with acute leukemia, multiple myeloma, bone marrow metastases, with aplastic anemia, to determine the extent of the lesion at different stages of the disease, it is performed repeatedly. to T.: pronounced (pathological).

Trepan is arranged according to the type of puncture-biopsy needle; it consists of a hollow cylindrical needle with a mandrin (sometimes without it) and a handle, which is connected to the cutter-trocar with a screw thread or nut. Trepans differ in the length of the needle (3-16 cm), diameter (inner 2-4 mm), peripheral end device.

A trephine biopsy is performed in the region of the right or left upper anterior or upper posterior iliac spines in compliance with the rules of asepsis and. Depending on the puncture site, the patient is placed on his back or on his side, sometimes on. After local anesthesia of the skin, subcutaneous tissue, periosteum with a 2% solution of novocaine, the skin is pierced with an eye scalpel and a trephine is injected under some pressure with a rotational-translational movement through a plate of compact substance into a spongy substance. The needle is removed by rotating it in the same direction.

The material obtained from the cavity of the trephine is pushed out with a mandrin with a blunt end. It is recommended to prepare smears before immersing the material in the fixing fluid. Histological processing includes fixation, decalcification, passage through, followed by pouring into or paraffin-celloidin. Sections are stained with hematoxylin and eosin, azure-eosin. The results of the study are interpreted taking into account clinical picture and other laboratory data.

II Trepanobiopsy (Trepano- + )

a biopsy of a section of the bone marrow by puncture, usually the ilium, using a special needle.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

Synonyms:

See what "Trepanobiopsy" is in other dictionaries:

Trepanobiopsy… Spelling Dictionary

Exist., Number of synonyms: 1 biopsy (2) ASIS Synonym Dictionary. V.N. Trishin. 2013 ... Synonym dictionary

- (trepano + biopsy) biopsy of a section of the bone marrow by puncturing usually the ilium with a special needle ... Big Medical Dictionary

trephine biopsy- trepanobiopsy / I, and ... merged. Separately. Through a hyphen.

Pinsky Semyon Borisovich Date of birth: February 26, 1936 (1936 02 26) (76 years old) Place of birth: Kyiv Country ... Wikipedia

File:PinskySB.jpg Pinsky Semyon Borisovich Semyon Borisovich Pinsky (born February 26, 1936 in Kyiv - doctor medical sciences, Honored Scientist and Honored Doctor Russian Federation, head of the department of general surgery, honorary ... Wikipedia

File: PinskySB.jpg Pinsky Semyon Borisovich Semyon Borisovich Pinsky (born February 26, 1936 in Kyiv - Doctor of Medical Sciences, Honored Scientist and Honored Doctor of the Russian Federation, Head of the Department of General Surgery, Honorary ... Wikipedia