OncologyTier 2Topic

Indication and complications of bone marrow transplant

Role

Bone marrow aspiration and trephine biopsy sample the marrow for diagnosis, staging, and monitoring of haematological malignancy and marrow infiltration by solid tumours
A core investigation in suspected leukaemia, lymphoma staging, and unexplained cytopenia - typically performed from the posterior iliac crest

Aspiration provides cellular detail (cytology, flow cytometry, cytogenetics, molecular studies) but can be affected by "dry tap" (fibrosis, densely packed marrow, or technical factors)
Trephine (core) biopsy provides architecture - essential for assessing marrow cellularity, fibrosis, and focal infiltration (e.g. lymphoma, metastatic carcinoma) that aspiration alone can miss, particularly when the marrow is patchily involved

Indications: diagnosis and staging of leukaemia/lymphoma, unexplained cytopenia not explained by peripheral causes, suspected marrow infiltration by metastatic solid tumour, myeloma workup, pyrexia of unknown origin with suspected marrow involvement
A "dry tap" on aspiration itself is diagnostically informative - suggests marrow fibrosis or densely infiltrated/packed marrow (e.g. myelofibrosis, some leukaemias) and should prompt reliance on the trephine biopsy

Generally a safe, well-tolerated outpatient procedure; complications are uncommon - bleeding (higher risk with thrombocytopenia/anticoagulation, though the procedure is usually still safe with appropriate precautions), infection, pain at the site, rarely bone fracture in osteoporotic/heavily infiltrated bone

Acute and chronic leukaemias, lymphoma staging, myeloma, myelofibrosis, unexplained cytopenia, metastatic carcinoma marrow infiltration

Both aspirate and trephine are usually performed together, since each provides complementary information the other cannot fully substitute for

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