The procedure starts by finding the correct level for the biopsy.
The biopsies are taken from the upper iliac crest with access via the ventral spine.
The midline of the spineous process is identified,
and the iliac crest is located by palpation.
When the correct point is found, the puncture point is marked using a straw.
This is to avoid losing the marking after washing.
The area around the puncture point is washed with colored chlorhexidine.
The procedure is carried out asepticly, but without sterile drapes.
The area around the puncture point must remain sterile during the whole procedure.
Correct placement of local anasthesia is important for how the patient experiences the procedure.
Ten milliliters of Xylocain, with 10 milligrams per milliliter of adrenaline is normally used.
When the needle reaches the periosteum the anesthesia is given time to work
before the number area is expanded by angling the needle in four directions.
To avoid unnecessary trauma to the skin from the aspiration needle,
a small incision is made in the skin with a scalpel blade.
Disposable and reusable aspiration needles are available.
A reusable needle is used in this video.
The needle is pushed toward the posterior iliac spine
and rotated with careful pressure until it goes through the cortex.
When the needle is in the spongy tissue the trocar is removed,
and a five milliliter syringe is connected to the needle.
.2 to 2 milliliters is quickly aspirated for a regular bone marrow smear.
Three small ad seven larger smears are placed on slides
the slides are tilted and the blood which collects in the lower edge of the smear
is removed before it coagulates.
We then use another slide to make a few regular smears, and some which are squeezed.
The smears are dried with the fan before fixation and staining.
A new aspiration needle is used for aspiration for flow cytometry.
.5 milliliters of Aminopyrin is placed in the syringe in advance
to stop the aspirate coagulating.
4 to 5 millilitres is aspirated with the syringe
The aspirate is quickly moved to a specimen glass.
Finally a punch biopsy is taken.
A disposable needle is used.
The needle is inserted in the same puncture wound and pushed toward the posterior crest.
The needle is rotated with constant pressure until it penetrates the iliac crest.
Care is taken to ensure that the needle does not slide into an area that is not anesthetized.
The trocar is removed from the needle
the rotation of the needle is continued until it has penetrated deep enough
into the bone marrow.
The spoon is inserted into the needle
The biopsy needle is rotated, without pressure, in both directions to cut the biopsy loose.
The needle ,with spoon and biopsy, is pulled out.
The spoon is carefully removed from the needle
and the biopsy is put in fixation fluid using a blunt trocar.
The incision is closed with strips and covered with an adhesive bandage.