¿Cómo se hace un aspirado de médula ósea?

Bone marrow puncture (bone marrow puncture) is a commonly used diagnostic technique for taking bone marrow fluid, and its inspection contents include cytology, protozoa and bacteriology indications 1. Diagnosis of various leukemias. 2. It is helpful for the diagnosis of iron deficiency anemia, hemolytic anemia, aplastic anemia, malignant histiocytosis and other blood diseases. 3. Diagnose some malignant tumors, such as multiple myeloma, lymphoma, bone marrow metastases, etc. 4. Inspection of parasitic diseases, such as looking for malaria parasites, kala-azar pathogens, etc. 5. Bacterial culture of bone marrow fluid. Contraindications Bone marrow aspiration is forbidden for hemophiliacs. In patients with bleeding tendency, special attention should be paid to the operation. Preparation Equipment preparation: bone marrow puncture bag, gloves, treatment tray (iodine, ethanol, cotton swabs, tape, local anesthetics, etc.), and medium for bacterial culture. Preparation of the manikin: the manikin is in the supine position operation method 1. Puncture site: 1-2cm behind the anterior superior iliac spine. 2. Disinfect the skin of the puncture area. Undo the piercing bag. Wear sterile gloves. Check the instruments in the puncture bag. Lay sterile hole towels. 3. Use 1 percent procaine for skin, subcutaneous and periosteal anesthesia at the puncture point. 4. Fix the fixator of the bone marrow puncture needle at 1{{30}}1.5cm away from the needle tip. Use the thumb and index finger under the left hand to pull and secure the skin on both sides of the iliac crest. Use the right hand to hold the needle and pierce vertically to the bone surface. When the needle touches the bone, turn the puncture needle left and right to slowly drill into the bone. When the resistance is reduced and the puncture needle has been fixed in the bone to stand upright. 5. Pull out the core of the needle, connect it to a sterile and dry 10ml or 20ml syringe, and suck with appropriate force, that is, a small amount of red bone marrow fluid enters the syringe. Absorb about 0.2ml of bone marrow fluid for smear. For bacterial culture of bone marrow fluid, 1.5ml can be aspirated. If the bone marrow fluid cannot be extracted, the needle can be put back into the heart, rotated a little or continue to drill a little, and then aspirated again. 6. After obtaining the bone marrow fluid, quickly pull out the syringe and puncture needle. Cover the puncture site with sterile gauze, press for 1 to 2 minutes, and then fix it with adhesive tape. Quickly place the bone marrow droplets taken out on a glass slide for smearing. For bacterial culture, the bone marrow fluid is injected into the culture medium. QA 1. What are the indicators for judging good bone marrow sampling? (1) For a moment when the bone marrow is aspirated, the patient has a special pain. (2) The extracted bone marrow fluid contains small fat particles. (3) Bone marrow-specific cells can be seen under the microscope. Such as megakaryocytes, plasma cells, histiocytes, primitive and immature granules, red blood cells. (4) The ratio of rod-shaped nucleus cells to segmented nucleus cells in the differential count of bone marrow cells was greater than that of the blood sheet cell classification. 2. What are the parts of bone marrow aspirate? Generally, the anterior superior iliac spine is selected as the puncture point. If necessary, the posterior superior iliac spine, vertebral spinous process, sternum, anterior and inferior tibial tuberosity can also be selected. 3. What is the position of sternum bone marrow puncture, needle insertion direction and needle insertion depth? The puncture point is at the level of the second intercostal space on the midsternal line. The direction of needle insertion is 30 to 45 degrees from the bone surface, and it is inclined cephalad. The needle depth is about 1cm. 4. When taking bone marrow for cytological examination, what is the appropriate amount of bone marrow fluid to be aspirated? Aspirate 0.2ml is appropriate, because too much aspirate will dilute the bone marrow fluid with blood. 5. What are the possibilities of not being able to extract bone marrow fluid? (1) The puncture position is not good, and the marrow cavity is not reached. (2) The needle tube is blocked by subcutaneous tissue or bone fragments. (3) "Dry pumping" may occur in some diseases, such as myelofibrosis, hyperplasia of bone marrow nucleated cells (chronic myeloid leukemia, etc.). Experiment summary This bone marrow puncture course uses a puncture simulator to conduct an intuitive demonstration, which improves the students' interest in learning, and the students feel real and have a deep memory.

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