Chapter 21: Haematological procedures
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Definitions
- Bone marrow procedures involve the removal of haematopoietic tissue from the medullary cavity of bone. Tissue is removed by either aspiration or biopsy (Al‐Ibraheemi et al. [2], Hoffbrand and Moss [51], Odejide et al. [89]). Specific procedures include the following.
- Aspiration and trephine biopsy. Biopsy of the bone marrow is an indispensable tool for the study of diseases of the blood and may be the only way in which a correct diagnosis can be made. Marrow is usually obtained by needle aspiration and percutaneous trephine biopsy. If performed correctly, bone marrow aspiration is simple and safe; it can be repeated many times and performed on outpatients (Hoffbrand and Moss [51], Lewis et al. [69], Moore et al. [80]). Trephine biopsy is a little less simple, but is invaluable in the diagnosis of conditions which yield a ‘dry tap’ on bone marrow aspiration (e.g. myelofibrosis, infiltrations) or when disrupted architecture of the marrow is an important diagnostic feature (e.g. Hodgkin's disease, lymphoma). It is also performed on outpatients (Lewis et al. [69]).
- Bone marrow harvest. Traditionally bone marrow harvest was the primary method of collecting stem cells in order to perform a haematopoietic stem cell transplant (Richardson and Atkinson [98]). The process is similar to that of bone marrow aspiration but multiple aspirations are needed from each posterior iliac crest in order to obtain the necessary volume of stem cells (Yarbro et al. [116]). The procedure is performed in the operating room with the donor anaesthetized and this is usually an inpatient procedure (Yarbro et al. [116]).
- Apheresis is the generic term applied to blood cell separator procedures, which may be used for donor or therapeutic purposes. Cell separators remove whole blood from a patient or donor and separate this into component parts to allow a desired element to be collected, while returning the remainder to the patient or donor (Corbin et al. [25]). Separation of the blood components can be accomplished by filtration, centrifugation or a combination of both. Filtration takes advantage of differences in particle size to separate blood plasma from the cellular elements. Centrifugation uses differences in specific gravity to separate and isolate blood components (Burgstaler [18]). The specific procedures are described according to the blood element being removed (Kaushansky et al. [63]):
- leukapheresis (white cell depletion)
- thrombocytopheresis (platelet depletion)
- erythrocytapheresis (red cell exchange)therapeutic plasmapheresis (plasma exchange).
- Ribavirin is a drug that inhibits a wide range of DNA and RNA viruses by disrupting viral protein synthesis (Joint Formulary Committee [62]). It is generally given by inhalation for the treatment of severe bronchiolitis caused by the respiratory syncytial virus (RSV) and parainfluenza (Dignan et al. [33], Molinos‐Quintana et al. [79], Raboni et al. [96]). It may occasionally be given intravenously for infection in sites other than the lungs.
- Pentamidine isetionate is a synthetic amidine derivative, and is an antiprotozoal and antifungal agent that interferes with DNA replication and function. It is effective in the treatment of some fungal infections, specifically Pneumocystis jirovecii (previously carinii) pneumonia. It is also useful in treating trypanosomiasis and leishmaniasis (Sun and Zhang [108]).
