Sternary puncture is one of the methods of studying the bone marrow, which is performed by puncturing the anterior wall of the sternum. Bone marrow is the central organ of hematopoiesis, which is a soft mass filling in the bones all spaces not occupied with bone tissue.
Indications for sternal puncture
Sternary puncture is performed in the diagnosis of diseases of the circulatory system and provides important information about the prognosis of the disease. This procedure may be imposed if you suspect:
- leukemia;
- anemia ;
- myelodysplastic syndromes;
- Gaucher's disease;
- Christen-Schuller's disease;
- visceral leishmaniasis;
- metastases of tumors in the bone marrow, etc.
It allows to assess the functional state of the bone marrow, to see the smallest changes in the process of hematopoiesis.
Preparing the patient for a sternal puncture
On the day of the study, the patient's water and diet should not be changed. The procedure is carried out not less than two hours after eating with a bladder and intestine empty.
Before conducting a puncture, you must stop taking all medications, except for vital medicines. Also on this day, any other medical and diagnostic measures are canceled.
The patient must explain the nature and procedure of the procedure, provide information on possible complications. After this, the patient's consent is given for the puncture.
Sternal puncture technique
Puncture of the bone marrow can be performed in outpatient settings:- Manipulation is carried out under local anesthesia in the position of the patient lying on his back. For the procedure of sternal puncture a special needle is used - the needle of Kassirsky. It is a short tubular needle that has a nut to limit the depth of immersion (to avoid accidental damage to the mediastinal organs), a mandrel (rod to close the lumen of the needle), and a removable handle that facilitates puncture.
- The puncture site is treated with alcohol and iodine solution.
- Further anesthesia is carried out - as a rule, 2% solution of novocaine is used. During the procedure of puncture, there may be slight sensations of pain when piercing and drawing a bone marrow into a syringe, comparable to an ordinary injection.
- The puncture is performed by a rapid rotational movement of the Kassirsky needle (with the mandrel inserted) along the middle line at the level of the second - third intercostal space. When a needle passes through a layer of cortical substance and enters the medullar space, a distinct sensation of failure arises. If there is any doubt as to whether the needle has penetrated the bone marrow, a check with aspiration is carried out.
- The syringe is attached to the needle after the mandrene is removed and about 0.2 to 0.3 ml of bone marrow is sucked. After that, the needle is removed from the sternum, and a sterile bandage is applied to the puncture site and fixed with a plaster adhesive.
- The obtained sample of bone marrow suspension is placed in a Petri dish, swabs are prepared on the slide, which later on
are examined under a microscope. The study of morphology and counting of bone marrow cells is carried out.
Complications of the sternal puncture
Adverse effects of the sternal puncture can be a through sternum puncture and bleeding from the puncture site. Through puncture is most likely in the procedure of the child due to greater elasticity of the sternum and involuntary movements of the child. Caution should be exercised when performing manipulation in patients taking long-term corticosteroids (because they are able to have osteoporosis ).