Marrow biopsy in the diagnosis of pyrexia of undetermined origin

The bone marrow as a source of laboratory studies

The intraosseous route is an emergency alternative to the IV route for the administration of drugs and fluids. Another emergency function of intravascular access is obtaining blood samples for blood gases, laboratory studies, and blood cultures. One of the drawbacks to using the intraosseous route as an alternative to IV access has been the persistent need to establish IV access to obtain blood samples. We obtained bone marrow samples from ten healthy anesthetized dogs and analyzed the usefulness of the samples in providing meaningful laboratory studies when compared with simultaneous arterial and venous samples for blood electrolytes, blood chemistries, blood gases, and hemoglobin. There was no significant difference (P greater than .10) in blood electrolytes (sodium, potassium, chloride, and carbon dioxide) drawn from the intraosseous, arterial, and venous sites. The blood chemistries (blood urea nitrogen, creatinine, total protein, albumin, calcium, phosphorous, uric acid, total bilirubin, and SGOT) also were not significantly different (P greater than .10). Significant differences were obtained for glucose comparing intraosseous with arterial (P = .03), whereas intraosseous versus venous was only marginally significant (P = .06). Significant differences were also obtained for alkaline phosphatase when comparing intraosseous with arterial (P = .03), whereas comparison with venous was only marginally significant (P = .06): lactate dehydrogenase differences were marginally significant when comparing intraosseous with arterial (P = .09) and venous (P = .06) blood. Hemoglobin values were not significantly different when comparing results for the three sites (P greater than .25).(ABSTRACT TRUNCATED AT 250 WORDS)

Bone marrow biopsy in children: a study of 111 patients

Closed trephine needle biopsy of the bone marrow has become an established procedure in the evaluation of many malignant and benign diseases in adults; however, its role in pediatric pathology has not yet been defined. In the period from February 1974 to April 1978 we have performed 164 such biopsies in 111 children under 15 years of age. A representative specimen has been obtained in over 80% of cases. This series included, in order of frequency, non-Hodgkin lymphomas, Hodgkin lymphomas, aplastic anemias, rhabdomyosarcomas, neuroblastomas, miscellaneous solid tumors, and single cases of histiocytosis X, malignant histiocytosis, sarcoidosis, malignant histiocytoma, and Castleman lymphoma of the hyaline-vascular type. Histology has been found superior to cytology in the detection of neuroblastoma invasion; the evaluation of the true cellularity in aplastic anemia, and the detection of granulomatous tissue in the only case of sarcoidosis. In other diseases histology and cytology gave similar information, except for the few cases of acute leukemia in partial relapse, which has been better defined in the aspirate smears than in the core specimen. Further evaluation of this technique in other patient series appears advisable.