Central Mindanao University

College of Nursing
University Town, Musuan, Maramag 8710
Bukidnon
Tel No. 088-356-1910/13 Tele Fax No. 088-356-1912
Email add: nursing@cmu.edu.ph
Website: www.cmu.edu.ph

Ward Class

Prepared by:
Mejos, Mary Grace V.

Topics:
Bone Marrow Biopsy
GeneXpert

September 12, 2017

 Bone Marrow Biopsy

A bone marrow biopsy is a test that takes a sample of your solid bone tissue. This test
looks for abnormalities in your blood cells and signs of any diseases. Bone marrow is the soft
tissue inside bones that helps form blood cells. It is found in the hollow part of most bones.

Bone marrow biopsy is not the same as bone marrow aspiration. An aspiration
removes a small amount of marrow in liquid form for examination.

How the Test is performed

A bone marrow biopsy may be done in the health care provider's office or in a hospital. The
sample may be taken from the pelvic or breast bone. Sometimes, another area is used.

Marrow is removed in the following steps:

If needed, you are given medicine to help you relax.

The provider cleans the skin and injects numbing medicine into the area and surface of the
bone.

A biopsy needle is inserted into the bone. The center of the needle is removed and the
hollowed needle is moved deeper into the bone. This captures a tiny sample, or core, of bone
marrow within the needle.

The sample and needle are removed.

Pressure and then a bandage are applied to the skin.

A bone marrow aspiration may also be done, usually before the biopsy is taken. After the skin
is numbed, the needle is inserted into the bone, and a syringe is used to withdraw the liquid
bone marrow. If this is done, the needle will be removed and repositioned. Or, another needle
may be used for the biopsy.

How to Prepare for the Test

Tell the provider:

If you are allergic to any medicines

What medicines you are taking

If you have bleeding problems

If you are pregnant

 How the Test will feel
You will feel a sharp sting when the numbing medicine is injected. The biopsy needle may
also cause a brief, usually dull, pain. Since the inside of the bone cannot be numbed, this test
may cause some discomfort.

If a bone marrow aspiration is also done, you may feel a brief, sharp pain as the bone marrow
liquid is removed.

Why the Test is performed

Your provider may order this test if you have abnormal types or numbers of red or white
blood cells or platelets on a complete blood count (CBC).
This test is used to diagnose leukaemia, infections, some types of anaemia, and other blood
disorders. It may also be used to help determine if a cancer has spread or responded to
treatment.

Normal Results
A normal result means the bone marrow contains the proper number and types of blood-
forming (hematopoietic) cells, fat cells, and connective tissues.

What Abnormal Results Mean

Abnormal results may be due to cancers of the bone marrow (leukaemia, lymphoma, multiple
myeloma, or other cancers).

The results may detect the cause of anaemia (too few red blood cells), abnormal white blood
cells, or thrombocytopenia (too few platelets).
Specific conditions for which the test may be performed:

A body-wide fungal infection (disseminated coccidioidomycosis)

A white blood cell cancer called hairy cell leukaemia

Cancer of the lymph tissue (Hodgkin or non-Hodgkin lymphoma)
Bone marrow doesn't make enough blood cells (aplastic anaemia)
Blood cancer called multiple myeloma
Group of disorders in which not enough healthy blood cells are made (myelodysplastic
syndrome; MDS)

A nerve tissue tumour called neuroblastoma

Bone marrow disease that leads to an abnormal increase in blood cells (polycythaemia)
Abnormal protein build up in tissues and organs (amyloidosis)
Bone marrow disorder in which the marrow is replaced by fibrous scar tissue (myelofibrosis)
Bone marrow produces too many platelets (thrombocythemia)
White blood cell cancer called Waldenstrm macroglobulinemia
Risks
There may be some bleeding at the puncture site. More serious risks, such as serious bleeding
or infection, are very rare.

GeneXpert
GeneXpert MTB/RIF Assay

Is a rapid diagnosis test of Tuberculosis (TB) and drug resistance. It is

revolutionizing TB control with aids in prompt diagnosis and treatment (selection of
appropriate TB regimen).
Is a nucleic acid amplification (NAA) test which simultaneously detects DNA
of Mycobacterium tuberculosis complex (MTBC) and resistance to rifampin (RIF)
(i.e. mutation of the rpoB gene) in less than 2 hours. In comparison, standard cultures
can take 2 to 6 weeks for MTBC to grow and conventional drug resistance tests can
add 3 more weeks.

Basic Procedure:

1. Collect sputum sample from the patient with suspected TB.

2. The sputum is mixed with the reagent that is provided with the assay, and a cartridge
containing this mixture is placed in the GeneXpert machine.
3. All processing from this point on is fully automated.

Advantages of the Xpert MTB/RIF Assay

1. Time efficient methods for detecting Mycobacterium tuberculosis bacteria and mutations
isoniazid (INH) resistance.
2. Availability of quick test results leads to improved patient management and outcomes, and
preventing unnecessary use of resources (avoiding unnecessary treatment, respiratory
isolation).
3. Fully automated system; minimal technical training is required to run the test.
4. Prompt (quick) identification of multidrug-resistant TB (MDR TB)* cases as resistance to
RIF, in most instances, co-exists with resistance to INH. Rapid diagnosis of rifampin
(RIF) resistance potentially allows TB patients to start on effective treatment much sooner
than waiting for results from other types of drug susceptibility testing. If rifampin
resistance is detected, confirmation of resistance can be done by DNA sequencing.
*MDR TB is TB that is resistant to both isoniazid (INH) and Rifampicin (RIF).
Interpretation of GeneXpert results:

Results of GeneXpert should be interpreted along with clinical, radiographic, and other
laboratory findings. The Xpert MTB/RIF assay does not replace the need for smear with
microscopy for acid-fast bacilli, culture for mycobacteria, and growth-based drug
susceptibility testing, in addition to genotyping for early discovery of outbreaks.

Results from the Xpert MTB/RIF assay indicate whether or not MTBC was detected in the
sample. In some instances, the result is invalid, whereby the test should be repeated.

If MTBC was detected, the results will also state whether resistance to RIF was

Detected: Mycobacteria have a high probability of resistance to RIF; should be confirmed

by additional testing. If RIFs resistance is confirmed, rapid molecular testing for drug
resistance to both first-line and second-line drugs should be performed so that an effective
treatment regimen can be selected.
Not detected: Mycobacteria are probably susceptible to RIF; all tests that are positive for
MTBC should have growth-based susceptibility testing to first-line TB drugs.
Indeterminate: the test could not accurately determine if the bacteria are resistant to RIF.
Growth-based susceptibility testing to first-line TB drugs should be performed.

NOTE: Regardless of the Xpert MTB/RIF result, Center of Disease Control (CDC) strongly
recommends a comprehensive testing algorithm that includes AFB smear and mycobacterial
culture as well as drug susceptibility testing (DST) and genotyping.

Limitation of Nucleic Acid Amplification (GeneXpert) System

A negative NAA test result does not exclude the possibility of a positive culture.
A positive NAA test result does not differentiate between the species of MTBC or
determine the presence of other Mycobacteria species.
Isolates are required for all positive MTB patients in order to perform culture-based
drug susceptibility testing and genotyping.

References

Chernecky CC, Berger BJ. Bone marrow aspiration analysis-specimen (biopsy, bone marrow
iron stain, iron stain, bone marrow). In: Chernecky CC, Berger BJ, eds. Laboratory Tests and
Diagnostic Procedures. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:241-244.

Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In:
McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory
Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 30.
Name:

Encircle the correct answer.

1) It is a test that takes a sample of your solid bone tissue. This test looks for
abnormalities in your blood cells and signs of any diseases.
A. Bone Aspiration C. Bone Marrow Aspiration
B. Bone Marrow Biopsy D. Bone Biopsy
2) It is the soft tissue inside bones that helps form blood cells.
A. Bone Marrow C. Soft Tissue
B. Bone Soft Tissue D. Tissue
3) Why is this test performed?
A. To determine if you have abnormal types or numbers of red or white blood cells
or platelets on a complete blood count.
B. To diagnose leukaemia, infections, some types of anaemia, and other blood
disorders.
C. Both A and B. D. A only.
4) This is how to prepare the test, you must tell to the provider, except;
A. If you are allergic to any medicines C. If you are pregnant
B. If you have bleeding problems D. None of the above
5) It is a specific condition; cancer of the lymph tissue.
A. Hodgkin or non-Hodgkin lymphoma C. Polycythaemia
B. Amyloidosis D. Thrombocytopenia
6) Bone marrow disease that leads to an abnormal increase in blood cells.
A. Hodgkin or non-Hodgkin lymphoma C. Polycythaemia
B. Amyloidosis D. Thrombocytopenia
7) Abnormal protein build up in tissues and organs.
A. Hodgkin or non-Hodgkin lymphoma C. Polycythaemia
B. Amyloidosis D. Thrombocytopenia
8) A body-wide fungal infection.
A. Disseminated coccidioidomycosis C. Neuroblastoma
B. Disseminated candidiasis D. Leukaemia
9) A nerve tissue tumour.
A. Disseminated coccidioidomycosis C. Neuroblastoma
B. Disseminated candidiasis D. Leukaemia
10) A white blood cell cancer.
A. Disseminated coccidioidomycosis C. Neuroblastoma
B. Disseminated candidiasis D. Leukaemia
11) It is a rapid diagnosis test of Tuberculosis (TB) and drug resistance.
A. GeneXpert MTB/RIF Assay C. Tuberculosis Analysis
B. MTB/RIF Assay D. None of the above
12) This are the advantages of this test, except;
A. Availability of quick test results leads to improved patient management and outcomes,
and preventing unnecessary use of resources (avoiding unnecessary treatment,
respiratory isolation).
B. Fully automated system; minimal technical training is required to run the test.
C. Time consuming methods for detecting Mycobacterium tuberculosis bacteria and
mutations isoniazid (INH) resistance.
D. None of the above.
13) This is the basic procedure; Collect sputum sample from the patient with suspected
TB. The sputum is mixed with the reagent that is provided with the assay, and a
cartridge containing this mixture is placed in the GeneXpert machine. All processing
from this point on is fully automated.
A. True B. False C. Maybe D. None of the above
14) NAA stands for
A. Nucleus Acid Amplification C. Nucleus Acid Administration
B. Nucleic Acid Amplification D. Nucleic Acid Administration
15) MTB stands for
A. Mycobacterium Tuberculosis C. Microbacterium Tuberculosis
B. Mycobacterium Tuberculosis Classification D. Microbacterium
Tuberculosis Complex
16) What is Mycobacterium Tuberculosis?
A. Mycobacterium tuberculosis is an obligate pathogenic bacterial species in the
family Mycobacteriaceae and the causative agent of tuberculosis.
B. Also known as Hansens bacillus spirilly, mostly found in warm tropical
countries, is a bacterium that causes leprosy. It is an intracellular, pleomorphic,
acid-fast, pathogenic bacterium.
C. Yeast infection results from an overgrowth of yeast (a type of fungus) anywhere
in the body.
D. None of the above

17-19) Select all that apply. Results of GeneXpert should be interpreted along with;
A. Clinical B. Radiographic C. Laboratory findings. D. None of these
20) What are the topics that Ive discussed?
A. Bone Marrow Biopsy and GeneXpert C. GeneXpert and Mycobacterium
B. Bone Marrow Biopsy and Mycobacterium D. All of the above
Answer Key:

1. It is a test that takes a sample of your solid bone tissue. This test looks for
abnormalities in your blood cells and signs of any diseases.
C. Bone Aspiration C. Bone Marrow Aspiration
D. Bone Marrow Biopsy D. Bone Biopsy
2. It is the soft tissue inside bones that helps form blood cells.
C. Bone Marrow C. Soft Tissue
D. Bone Soft Tissue D. Tissue
3. Why is this test performed?
D. To determine if you have abnormal types or numbers of red or white blood cells
or platelets on a complete blood count.
E. To diagnose leukaemia, infections, some types of anaemia, and other blood
disorders.
F. Both A and B. D. A only.
4. This is how to prepare the test, you must tell to the provider, except;
C. If you are allergic to any medicines C. If you are pregnant
D. If you have bleeding problems D. None of the above
5. It is a specific condition; cancer of the lymph tissue.
C. Hodgkin or non-Hodgkin lymphoma C. Polycythaemia
D. Amyloidosis D. Thrombocytopenia
6. Bone marrow disease that leads to an abnormal increase in blood cells.
C. Hodgkin or non-Hodgkin lymphoma C. Polycythaemia
D. Amyloidosis D. Thrombocytopenia
7. Abnormal protein build up in tissues and organs.
C. Hodgkin or non-Hodgkin lymphoma C. Polycythaemia
D. Amyloidosis D. Thrombocytopenia
8. A body-wide fungal infection.
C. Disseminated coccidioidomycosis C. Neuroblastoma
D. Disseminated candidiasis D. Leukaemia
9. A nerve tissue tumour.
C. Disseminated coccidioidomycosis C. Neuroblastoma
D. Disseminated candidiasis D. Leukaemia
10. A white blood cell cancer.
C. Disseminated coccidioidomycosis C. Neuroblastoma
D. Disseminated candidiasis D. Leukaemia
11. It is a rapid diagnosis test of Tuberculosis (TB) and drug resistance.
C. GeneXpert MTB/RIF Assay C. Tuberculosis Analysis
D. MTB/RIF Assay D. None of the above
12. This are the advantages of this test, except;
A. Availability of quick test results leads to improved patient management and outcomes,
and preventing unnecessary use of resources (avoiding unnecessary treatment,
respiratory isolation).
B. Fully automated system; minimal technical training is required to run the test.
C. Time consuming methods for detecting Mycobacterium tuberculosis bacteria and
mutations isoniazid (INH) resistance.
D. None of the above.
13. This is the basic procedure; Collect sputum sample from the patient with suspected
TB. The sputum is mixed with the reagent that is provided with the assay, and a
cartridge containing this mixture is placed in the GeneXpert machine. All processing
from this point on is fully automated.
A. True B. False C. Maybe D. None of the above
14. NAA stands for
A. Nucleus Acid Amplification C. Nucleus Acid Administration
B. Nucleic Acid Amplification D. Nucleic Acid Administration
15. MTBC stands for
A. Mycobacterium Tuberculosis C. Microbacterium Tuberculosis Classification
B. Mycobacterium Tuberculosis Classification D. Microbacterium Tuberculosis
Complex
16. What is Mycobacterium Tuberculosis?
A. Mycobacterium tuberculosis is an obligate pathogenic bacterial species in the
family Mycobacteriaceae and the causative agent of tuberculosis.
B. Also known as Hansens bacillus spirilly, mostly found in warm tropical
countries, is a bacterium that causes leprosy. It is an intracellular,
pleomorphic, acid-fast, pathogenic bacterium.
C. Yeast infection results from an overgrowth of yeast (a type of fungus)
anywhere in the body.
D. None of the above

17-19) Select all that apply. Results of GeneXpert should be interpreted along with;
A. Clinical B. Radiographic C. Laboratory findings. D. None of these
20) What are the topics that Ive discussed?
A. Bone Marrow Biopsy and GeneXpert C. GeneXpert and Mycobacterium
B. Bone Marrow Biopsy and Mycobacterium D. All of the above
Bone Marrow Biopsy

What is Bone Marrow?

Bone marrow is the soft tissue inside bones that helps form blood cells. It is found in the
hollow part of most bones.

What is Bone Marrow Biopsy?

- It is a test that takes a sample of your solid bone tissue.

- This test looks for abnormalities in your blood cells and signs of any
diseases.

Why the Test is performed?

- To determine if you have abnormal types or numbers of red or white

blood cells or platelets on a complete blood count (CBC).
- This test is also used to diagnose leukaemia, infections, some types of
anaemia, and other blood disorders.

How to Prepare for the Test?

You must notify or tell to the provider;

a) If you are allergic to any medicines

b) What medicines you are taking
c) If you have bleeding problems
d) If you are pregnant

Specific conditions for which the test may be performed:

1. A body-wide fungal infection (disseminated coccidioidomycosis)

2. A white blood cell cancer called hairy cell leukaemia
3. Cancer of the lymph tissue (Hodgkin or non-Hodgkin lymphoma)
4. Blood cancer called multiple myeloma
5. Group of disorders in which not enough healthy blood cells are made
(myelodysplastic syndrome; MDS)
6. A nerve tissue tumour called neuroblastoma
7. Bone marrow disease that leads to an abnormal increase in blood cells
(polycythaemia)
8. Abnormal protein build up in tissues and organs (amyloidosis)
9. Bone marrow produces too many platelets (thrombocythemia)
10. White blood cell cancer called Waldenstrm macroglobulinemia
GeneXpert

What is GeneXpert MTB/RIF Assay?

- It is a rapid diagnosis test of Tuberculosis (TB) and drug resistance. It

is revolutionizing TB control with aids in prompt diagnosis and
treatment (selection of appropriate TB regimen).
- It is a nucleic acid amplification (NAA) test which
simultaneously detects DNA of Mycobacterium tuberculosis complex
(MTBC) and resistance to rifampin (RIF) (i.e. mutation of the rpoB
gene) in less than 2 hours.

What is Mycobacterium Tuberculosis?

- Mycobacterium tuberculosis is an obligate pathogenic bacterial species

in the family Mycobacteriaceae and the causative agent of
tuberculosis.

Advantages of the Xpert MTB/RIF Assay

- Time efficient methods for detecting Mycobacterium

tuberculosis bacteria and mutations isoniazid (INH) resistance.
- Availability of quick test results leads to improved patient management
and outcomes, and preventing unnecessary use of resources (avoiding
unnecessary treatment, respiratory isolation).
- Fully automated system; minimal technical training is required to run
the test.

Basic Procedure:

1. Collect sputum sample from the patient with suspected TB.

2. The sputum is mixed with the reagent that is provided with the assay, and a
cartridge containing this mixture is placed in the GeneXpert machine.
3. All processing from this point on is fully automated.

Results of GeneXpert should be interpreted along with clinical, radiographic, and other
laboratory findings.