WEBVTT

00:00:06.881 --> 00:00:09.134
The examination of bone marrow is crucial

00:00:09.134 --> 00:00:12.971
to aid in the diagnosis and treatment
of certain diseases and disorders.

00:00:13.096 --> 00:00:16.641
This is an invasive procedure,
and the specimen needs to be handled

00:00:16.641 --> 00:00:19.644
very carefully
to ensure proper processing.

00:00:19.811 --> 00:00:22.897
The procedure described
here is the collection of bone marrow

00:00:23.023 --> 00:00:26.026
from the posterior
iliac crest of the pelvis.

00:00:26.109 --> 00:00:29.946
In a small percentage of cases, bone
marrow can be obtained from other site,

00:00:29.946 --> 00:00:33.366
but those may present a higher risk
of complications to the patient.

00:00:34.242 --> 00:00:38.079
The procedure is performed by physicians
and other health care practitioners,

00:00:38.079 --> 00:00:42.042
who are assisted by medical laboratory
scientists or bone marrow technicians.

00:00:42.834 --> 00:00:47.338
Supplies needed include the bone
marrow tray, formalin vials for specimen

00:00:47.338 --> 00:00:51.301
preservation and storage,
lidocaine vials, heparin vials,

00:00:51.342 --> 00:00:54.512
alcohol preps, sterile gauze pads, glass

00:00:54.512 --> 00:00:57.766
cover slips, slides, disposable way bolts,

00:00:58.058 --> 00:01:01.770
extra needles,
forceps, assorted specimen tubes

00:01:01.770 --> 00:01:05.482
such as EDTA or Spes,
depending on the tests requested.

00:01:06.191 --> 00:01:08.693
Notepads, a ruler pistol

00:01:08.693 --> 00:01:12.822
wraps, and skin cleansing wipes
to remove iodine from the patient's skin.

00:01:12.822 --> 00:01:14.616
After the completion of the procedure.

00:01:16.076 --> 00:01:16.785
Following an

00:01:16.785 --> 00:01:19.996
explanation of the procedure
and after the patient has signed

00:01:19.996 --> 00:01:23.083
the provided consent form,
the patient is directed to lie

00:01:23.083 --> 00:01:25.877
on the examination
table in the prone position.

00:01:25.877 --> 00:01:29.672
The provider then locates the posterior
superior iliac crest.

00:01:30.256 --> 00:01:33.009
A permanent marker or pen
is used to designate

00:01:33.009 --> 00:01:35.804
where the needle will enter
the patient's skin.

00:01:35.804 --> 00:01:39.641
The site is then cleansed with iodine
swabs provided in the bone marrow tray.

00:01:40.391 --> 00:01:42.644
The provider dons sterile surgical gloves

00:01:42.644 --> 00:01:45.647
before handling any objects on the tray.

00:01:46.231 --> 00:01:48.399
A sterile drape provided in the tray is

00:01:48.399 --> 00:01:51.444
put around the site to create a sterile
field on the patient.

00:01:52.237 --> 00:01:55.406
Additional drapes may be used
if so desired, by the provider,

00:01:55.406 --> 00:01:58.993
to avoid body fluids coming in contact
with the patient's clothing.

00:02:00.036 --> 00:02:02.122
A small area is cleansed with an alcohol

00:02:02.122 --> 00:02:05.125
wipe to remove the iodine
at the entry point,

00:02:05.166 --> 00:02:09.254
and the site is anesthetized
with a generous amount of lidocaine.

00:02:09.671 --> 00:02:13.216
The technologist or technician assist
by holding the lighter

00:02:13.216 --> 00:02:17.470
cane vials, so the physician can both
see the label and can safely remove

00:02:17.470 --> 00:02:21.850
as much as needed to numb the surrounding
tissue and the periosteum of the bone.

00:02:22.100 --> 00:02:25.103
The physician may need to use
additional lidocaine.

00:02:25.436 --> 00:02:28.690
Some tests
require an anti coagulated specimen.

00:02:28.815 --> 00:02:32.318
This is accomplished by the addition
of heparin to sterile syringes

00:02:32.569 --> 00:02:36.281
prior to the collection of the specimen,
or pulling a syringe of bone

00:02:36.281 --> 00:02:39.284
marrow and adding it to a fresh EDTA tube.

00:02:39.367 --> 00:02:43.997
While the lidocaine is allowed to numb
the area, the technologists are technician

00:02:43.997 --> 00:02:48.251
hands as many sterile syringes
as needed to accommodate these requests.

00:02:48.501 --> 00:02:50.587
Using sterile technique,

00:02:50.587 --> 00:02:54.215
the technologist shows the label
to the practitioner and holds

00:02:54.215 --> 00:02:58.011
the bottle so a needle can be inserted
while maintaining the sterile field.

00:02:59.721 --> 00:03:00.221
A small

00:03:00.221 --> 00:03:04.100
incision is made in the skin
with a scalpel blade, and the Illinois

00:03:04.100 --> 00:03:08.146
aspiration needle is inserted
into the marrow cavity of the bone.

00:03:08.605 --> 00:03:12.275
A syringe is then attached to the needle,
and a small amount of bone

00:03:12.275 --> 00:03:17.322
marrow is aspirated and deposited
by the provider into a disposable boat.

00:03:18.072 --> 00:03:22.702
The technologist or technician examines
it for the presence of spicules

00:03:22.702 --> 00:03:27.999
and reports to the physician if they are
present is spicules are not present.

00:03:28.208 --> 00:03:31.211
An additional attempt may be necessary.

00:03:39.427 --> 00:03:40.970
While the provider is obtaining

00:03:40.970 --> 00:03:44.557
additional anticoagulation specimens
needed for other tests.

00:03:45.016 --> 00:03:48.519
The technologist makes aspirate
pull smears from the bone

00:03:48.519 --> 00:03:51.522
marrow specimen in the disposable
way boat.

00:03:51.648 --> 00:03:54.025
It is important that this is done quickly

00:03:54.025 --> 00:03:57.028
as the marrow will begin to coagulate
and form a clot.

00:03:57.445 --> 00:04:00.698
This is accomplished
by picking up bone marrow with spicules

00:04:00.949 --> 00:04:05.745
using a glass pasture
pipette, placing a single drop on 122

00:04:05.745 --> 00:04:10.708
by 22 millimeter cover slip, and placing
a second cover slip over the drop.

00:04:11.292 --> 00:04:14.420
The technologists
then gently pull them apart, creating

00:04:14.420 --> 00:04:18.925
a thin layer of cells that will later
be stained for morphologic evaluation.

00:04:19.842 --> 00:04:24.305
Once the required aspirate specimens
are collected, the provider will remove

00:04:24.305 --> 00:04:30.186
the smaller Illinois needle and insert
the needle to obtain a bone core biopsy.

00:04:31.854 --> 00:04:32.981
Once obtained,

00:04:32.981 --> 00:04:35.817
the core is removed from the needle
and placed in a new way.

00:04:35.817 --> 00:04:38.820
Boat visualized to ensure acceptability.

00:04:39.028 --> 00:04:41.739
Measured and the size is recorded.

00:04:41.739 --> 00:04:46.536
Touch preps are made by gently rolling
the core biopsy between two glass slides,

00:04:46.995 --> 00:04:51.124
allowing cells attached to the outside
of the core to deposit on the slides.

00:04:51.666 --> 00:04:54.335
The core is
then placed in a vial of formalin

00:04:54.335 --> 00:04:57.547
for further processing in the histology
laboratory.

00:04:57.839 --> 00:05:00.300
The provider is
then given a skin cleansing wipe

00:05:00.300 --> 00:05:03.344
to remove the iodine
from the skin of the patient, covers

00:05:03.344 --> 00:05:06.306
the insertion site with a bandage,
and applies pressure.

00:05:07.890 --> 00:05:11.352
The aspirate smears are labeled
with an approved permanent marker.

00:05:11.978 --> 00:05:15.606
Smears are blotted with paper to remove
excess fat globules.

00:05:16.691 --> 00:05:19.485
The original aspirate
sample is allowed to clot

00:05:19.485 --> 00:05:22.905
and is put in to wrap
and placed in a clean formalin vial.

00:05:23.948 --> 00:05:25.700
Specimens and syringes are

00:05:25.700 --> 00:05:28.995
labeled with patient name,
medical record number,

00:05:29.454 --> 00:05:33.416
date, time,
and the technologists identity.

00:05:34.375 --> 00:05:37.628
The area is cleaned
and the specimens are sent for testing.

00:05:38.129 --> 00:05:41.132
The specimen slides are placed
in their own bag and sealed,

00:05:41.424 --> 00:05:45.678
while the formalin specimens and paperwork
are placed in a separate bag.

00:05:45.845 --> 00:05:49.349
To avoid partial
and inappropriate fixation of the slides.