Standardized Operation Methods And Quality Control Precautions Of Bone Marrow Biopsy

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Bone marrow biopsy is a standardized minimally invasive invasive operation, and the quality of operation directly determines the integrity of specimens and the accuracy of pathological diagnosis. Different from simple bone marrow puncture and fluid aspiration, biopsy needs to obtain complete solid bone marrow tissue through professional biopsy needles and standardized operation techniques. At present, clinical mainstream operation methods are divided into annular cutter biopsy and trephine biopsy. The two methods have their own technical characteristics and applicable scenarios, and standardizing the operation process is the key to ensure successful sampling and qualified specimens. Meanwhile, strict implementation of intraoperative and preoperative quality control precautions can effectively avoid surgical complications and specimen failure, and lay a foundation for high-quality pathological detection.

Annular cutter biopsy is a classic and widely used clinical biopsy technique, with stable sampling effect and high specimen integrity. The core equipment of this method is the annular cutter with a spiral side cutter notch at the top of the cannula. The standard operation process is highly standardized: first, assemble the needle core and cannula, and perform routine disinfection, anesthesia and positioning according to the bone marrow puncture standard; after the needle body smoothly penetrates the cortical bone and enters the bone marrow cavity, withdraw the inner needle core, install the professional extender, and reinsert the needle core to fix the equipment position. Then rotate the needle body clockwise downward, with the penetration depth controlled at 1 to 1.5 cm, so that the spiral side cutter can completely cut and wrap the bone marrow tissue. After reaching the preset depth, rotate upward clockwise to separate the bone marrow tissue from the basal part, and slowly withdraw the puncture needle. Finally, push the complete bone marrow tissue specimen from the cannula to a clean glass slide with a probe, fix it with 10% formalin for pathological biopsy, and make smear observation of the residual bone marrow fluid on the slide to realize dual detection of tissue and cell morphology.

Trephine biopsy is an efficient and convenient improved technique, which is suitable for most routine clinical biopsy scenarios. The operation steps are simpler and more efficient: after the bone marrow biopsy needle penetrates the cortical bone in place, directly withdraw the inner needle core, rotate the trephine cannula clockwise downward, and use the spiral cutting structure of the needle body to screw the bone marrow tissue into the cannula. Control the penetration depth stably at 1 to 1.5 cm to ensure sufficient and complete tissue specimens, then slowly withdraw the needle body, and take out the complete bone marrow core tissue through a probe for formalin fixation and inspection. This method has the advantages of simple operation, short time consumption and high sampling success rate, and is widely used in routine clinical screening and reexamination.

On the basis of standardized operation methods, strict implementation of full-process quality control precautions is essential to avoid operation risks and specimen failure. Preoperative detection is the first line of safety defense: coagulation time detection must be completed before operation. For patients with thrombocytopenia, coagulation dysfunction and other bleeding tendencies, the operation scheme needs to be optimized, and intraoperative compression hemostasis time needs to be prolonged to prevent bleeding complications. In terms of specimen quality control, all puncture needles and aspiration syringes must be kept completely dry. Residual water will cause hemolysis of bone marrow cells, destroy cell morphology and tissue structure, and directly lead to invalid specimens.

Intraoperative equipment and operation standardization are the core links of quality control. Before operation, it is necessary to carefully check the firmness of the connection of each part of the puncture needle to avoid needle body fracture caused by excessive swing during penetration. When the needle tip penetrates the cortical bone, the penetrating direction must be kept perpendicular to the bone marrow cavity. This vertical penetrating mode can not only ensure complete cutting and extraction of bone marrow tissue, but also effectively prevent excessive penetration of the needle body from damaging adjacent blood vessels, nerves and visceral tissues, ensuring operation safety.

In addition, the sampling volume and post-sampling treatment directly affect the diagnostic effect. Excessive aspiration of bone marrow fluid will cause serious hemodilution, dilute the proportion of nucleated cells, affect the accurate judgment of bone marrow hyperplasia degree, cell count and cell classification results, and lead to deviation of diagnostic conclusions. After the bone marrow fluid is extracted, smear production must be completed immediately. Bone marrow fluid has fast coagulation speed, and delayed operation will lead to integral coagulation of specimens and failure of smear detection. During the process of obtaining solid bone marrow specimens, the operation must be gentle and stable to avoid excessive extrusion and compression of tissues, prevent the destruction of bone marrow trabecular structure and cell morphology, and ensure the authenticity and effectiveness of pathological specimens.

In conclusion, bone marrow biopsy is a highly professional and standardized clinical operation. Mastering the two core biopsy operation methods and strictly implementing full-process quality control precautions can not only effectively reduce surgical safety risks, but also ensure the integrity and effectiveness of bone marrow specimens. Standardized operation and quality control are the key guarantees to give full play to the diagnostic value of bone marrow biopsy, and provide accurate and reliable pathological basis for clinical disease diagnosis, treatment evaluation and prognosis judgment.