[Health Lecture] "Will you become stupid after having your bone marrow extracted?" — Let's help you understand bone marrow puncture correctly

In order to ensure the popularization effect of learning health knowledge in the "2024 China Elderly Health Knowledge Competition", the organizer has collected various health science articles suitable for the elderly from various hospitals, and we will share them through the "Health Lecture" column. Today, Teacher Hou Yanli from the Department of Oncology and Hematology of Chongqing Traditional Chinese Medicine Hospital brought "Will you become stupid after taking bone marrow?" - Let us take you to correctly understand bone marrow puncture", and welcome elderly friends to learn. Are you familiar with this scene?

In clinical work, whenever doctors mention the need for bone marrow puncture to patients, most patients have this attitude. In fact, bone marrow puncture is not as scary as everyone thinks. Today, let's take a look at what bone marrow puncture is!

What is a bone marrow aspiration?

Bone marrow puncture, also known as bone marrow puncture, is a common diagnostic technique for collecting bone marrow fluid. In clinical practice, bone marrow fluid is often used for blood cell morphology examination, and can also be used for hematopoietic stem cell culture, cytogenetic analysis and pathogen biology examination to assist clinical diagnosis, observe efficacy and judge prognosis. In short, draw some bone marrow fluid for examination.

Why do we need bone marrow biopsy?

1. Understand the proliferation of hematopoietic cells in the bone marrow; 2. Whether there are any changes in the morphology of hematopoietic cells; 3. Whether there are other abnormal tissues in the bone marrow, such as cells and pathogens from other tissues and organs.

In what cases is bone marrow puncture necessary?

1. Anemia caused by various reasons and various types of leukemia, thrombocytopenic purpura, multiple myeloma, myelodysplastic syndrome, myelofibrosis, malignant histiocytosis, metastatic tumors, etc.; 2. Certain parasitic diseases, such as malaria, kala-azar, etc., can detect parasites; 3. Long-term fever, enlarged liver, spleen, and lymph nodes, and unclear diagnosis; 4. Follow-up of treatment for blood diseases.

What are the sites for bone puncture? 1. Posterior superior iliac spine puncture point: the protruding parts on both sides of the sacrum and above the buttocks, the positioning point is what we often call the "waist dimple"; 2. Anterior superior iliac spine puncture point: 1-2cm behind the anterior superior iliac spine on both sides, the positioning point is the "highest point" on both sides of our pelvis; the above two sites are the most commonly punctured points, easy to operate, and extremely low in risk. 3. Sternum puncture point: the manubrium and body of the sternum are equivalent to the first and second intercostal spaces. The positioning point is what we often call the "chest"; the sternum here is thinner, and there are large blood vessels and atria behind it, which poses a certain risk. However, due to the rich bone marrow fluid in the sternum, sternal puncture is still required when punctures at other sites fail. 4. Lumbar spinous process puncture point: the site where the lumbar spinous process protrudes, and operations are rarely performed at this site in clinical practice;

What are the contraindications for bone marrow puncture?

Strictly speaking, there are no absolute contraindications for bone puncture. The following are relative contraindications:

1. Coagulation disorders:

① Bone marrow puncture is contraindicated for hemophiliacs with severe bleeding.

② Bone marrow puncture is not suitable for patients with bleeding tendency or significantly prolonged coagulation time, but it can be performed for the purpose of clear diagnosis of the disease. After puncture, the local compression time for hemostasis needs to be appropriately prolonged.

2. Women in late pregnancy should be cautious when undergoing bone marrow puncture.

3. Sternocentesis should not be performed on children or uncooperative patients.

After reading this, I believe everyone has a certain understanding of bone puncture. Next, let’s answer the questions raised earlier!

1. Will bone marrow biopsy be painful? Will I become stupid after my bone marrow is extracted?

Bone marrow puncture is an invasive examination, which may cause some mild pain and soreness, just like "venous blood sampling", which most people can tolerate. During the operation, the doctor will give lidocaine and other anesthetic drugs for local anesthesia to relieve discomfort, so there is no need to be too afraid; the local pain and discomfort will gradually disappear in 3-4 days. Most people confuse bone marrow puncture with lumbar puncture. Bone marrow puncture extracts a very small amount of bone marrow fluid, not cerebrospinal fluid, which will not affect the brain and will not cause damage to important organs at all. 2. Will bone marrow puncture cause great harm to the body? "Serious damage to vitality"?

Bone marrow puncture is one of the routine hematology examinations. Like "venous blood sampling", the harm to the human body is almost negligible.

In the human body, bone marrow is the largest hematopoietic factory, where different types of hematopoietic stem cells and progenitor cells differentiate and continuously provide various blood cells for the human body. Generally, the amount of blood to be drawn is determined based on the items that the patient needs to test. Generally, bone marrow puncture extracts 0.1-2ml of bone marrow fluid, which will not cause harm to the human body; at the same time, the so-called "vital damage" is also caused by confusing "marrow" with "bone marrow" in traditional Chinese medicine, so there is no need to worry.

3. Is it appropriate to do a bone marrow biopsy for patients who suffer from paralysis, especially those with osteoporosis?

Bone marrow puncture is usually performed in a flat area with less subcutaneous fat. There are no important blood vessels and nerves, so it will not cause paralysis or pain in the lower limbs. The patient can walk normally after bone marrow puncture. If there is a little more bleeding during the operation, it is recommended to press to stop the bleeding and rest for about 10 minutes before getting up and moving around.

The site of bone puncture is the pelvis, which will not cause complications such as fractures in patients with osteoporosis.

4. Why is bone puncture necessary?

There are several reasons for repeated bone marrow puncture:

①During the initial diagnosis, two bone marrow biopsy examinations will be performed to ensure accuracy and avoid interference from various factors.

② For cases with more difficult diagnostic results, another bone marrow puncture will be performed to obtain more specimens for further examination to clarify the diagnosis.

③ Some diseases cause bone marrow fluid to be scarce and difficult to extract, such as aplastic anemia, which requires bone marrow punctures at multiple sites to observe bone marrow hematopoiesis.

④For some blood diseases, such as leukemia, bone marrow punctures will be performed more frequently. Bone marrow punctures are required regularly at multiple stages, including diagnosis, evaluation during treatment, and follow-up after treatment.

5. What precautions should be taken after bone marrow puncture?

Keep the puncture site clean and dry. Avoid getting it wet within 3 days to avoid secondary infection. The local wound will heal itself in about 1 week. Pay attention to whether there is bleeding or exudation at the puncture site. If there is bleeding or exudation, notify the medical staff in time and change the dressing.

Through the above links, I believe that everyone has a deeper understanding of bone marrow puncture. I hope that everyone does not need to panic about bone marrow puncture examination, actively cooperate with the doctor to complete the examination, make a clear diagnosis as soon as possible, guide effective treatment, and strive for early recovery.

Hou Yanli, Master of Medicine, attending physician, Department of Oncology and Hematology, Chongqing Traditional Chinese Medicine Hospital. Graduated from the Oncology Department of Chongqing Medical University, one of the fourth batch of young top talents of Chongqing Traditional Chinese Medicine Hospital, has been engaged in the diagnosis and treatment of blood diseases for a long time.

Social part-time jobs: Young Committee Member of the Hematology Branch of the Chinese Association of Traditional Chinese Medicine, Young Committee Member of the Hematology and Tumor Professional Committee of the Chongqing Anti-Cancer Association, Member of the Leukemia Group of the Hematology Branch of the Chongqing Medical Association, Member of the Clinical Anti-infective Drug Evaluation and Management Branch of the Chinese Medical Education Association, Member of the Popular Science and Health Education Working Committee of the Chinese Medical Education Association, presided over and participated in 6 national, provincial, ministerial and hospital-level research projects, published a total of 7 SCI and CSCD papers, participated in the editing of 2 monographs, and obtained 6 utility model invention patents.