Not all 3 smears have to be done. It depends on what the doctor orders. There are 2 parts to the bone marrow aspiration. The first is to get the aspirate and the second is to get the trephine sample. If the doctor orders for just the aspirate, the med tech only has to do the aspirate and the squash smears. If the doctor orders for both the aspirate and the trephine sample then the med tech will have to do all the 3 smears. Below are the pictures of the 3 different types of smears. (taken with permission from my supervisor)
Picture 1:
aspirate smear (with fragments)
Picture 2:
imprint smear (of trephine sample)
Picture 3:
squashed smear (from aspirate with fragements)
To Leslie,
Trephine is just the name of the instrument used to obtain the bone marrow biopsy. Items include:
- a 10 cc/mL syringe to inject the local anaesthetic.
- a 20 cc/mL syringe is used to withdraw the aspirate.
- 2 needles, 1 blue and 1 green. Blue is to withdraw the local from the bottle. Green is to inject the local into the biopsy site (hip bone area)
- Iodine and septanol to clean the biopsy site
- 2 tubes of local anaesthetic (1% xylocaine), in most cases. Some patients with low threshold of pain, in other words, unable to tolerate pain as well as others, will need more tubes.
- 1 dressing set
- 1 aspiration set which contains a special large-bore needle which is inserted into the hip bone area, the extraction cannula (trephine), a marked probe is used to check the length of the sample and also to expel the trephine sample from the trephine (extraction cannula).
To Yumei,
Few particles as in the fragments present in the aspirate. As shown is picture 1 above, those round things are known as fragments.
ADDITIONAL INFO: When the doctor withdraw the aspirate, there must be fragments present, or else it is rejected and the doctor will have to re-withdraw the aspirate again. If there really are no fragments present, just the blood or the doctor is unable to withdraw any aspirate from the patient, the doctor has no choice but to get another trephine sample and put it in the tube containing lithium heparin (for cytogenetics) and add 0.9% NaCl to act as a medium.
To Ben,
Myelodysplasia is a disorder of bone marrow stem cells due to ineffective hematopoiesis. Patients suffering from myelodysplasia may progress to acute myeloid leukaemia (AML) within months to a few years. It can be detected by doing a blood test. In most cases, there is a great decrease in RBCs, causing fatigue and pallor (anaemia). Rarely, there is a decrease in platelets which will lead to bruising and bleeding or a decrease in WBCs which will lead to fever and infection. At times, nonspecific symptoms like loss in weight and appetite may occur. It is because of the abnormal CBC results that lead to the decision of performing a bone marrow aspiration on the patient.
To cornelyus,
Yup, maygrundwald-giemsa stain contains methanol. Methanol is used to fix the smear to the slide so when it is washed, it will not be washed off.
To quan jun,
1) yup, I got to observe the bone marrow aspiration LIVE. =)
There are 2 parts to the procedure. The first part is to get the aspirate. The second part is to get the trephine sample. First, iodine followed by septanol is used to clean the biopsy site. Local anaesthetic is administered to numb the site. Then, a special large-bore needle is inserted and rotated. A syringe is then attached to the needle and the aspirate is withdrawn. For the second part, the needle is inserted further inside. A marked probe is inserted to check the length of the sample and removed. An extraction cannula is inserted into the needle cannula. The needle is then rotated and the extraction cannula is removed from the needle. The marked probe is used to expel the trephine sample from the extraction cannula.
As for the reagents used, I’m not sure what u meant. Or do u mean items used to carry out the aspiration? If yes, do refer to my answer to leslie above.
2) as for bone marrow fragments, do refer to the picture 1 above. They are fragments found in the aspirate from the bone marrow.
3) for this job-related question, I’m not sure which section u are referring to. But since u mentioned about processing samples, I’ll presume it’s the routine and coagulation section. For the routine section, we can process up till 250 to 400 samples a day for normal working hours (8am to 4pm). Monday is always the busiest day. After 4pm, the samples are left for those who are doing payback or night shift. There isn’t really a time limit given to process each sample. As long as there are samples received, we will just process it. During working hours, if the result of the sample is required by the doctor urgently, the samples are sent to the STAT lab.
For the coagulation samples, we can process up till 100 to approximately 200 samples a day during working hours (8am to 4pm). Urgent and non-urgent samples are run together. However, if the sample is really urgent like from the A&E section or so, we will try our best to run it first.
MALERIE (not malarie) =)
TG02
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