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Louise McNamara outlines an education programme that equips practitioners with the advanced skills and knowledge to provide a specialist service for patients with haematological malignancies
Abstract
A lack of formal bone marrow biopsy training for nurses led to the development of a course at the Royal Marsden for those working in haematology offering the knowledge and skills necessary to perform biopsies. This article describes the content and format of the module, including the theoretical knowledge and practical skills taught. It also provides more detail about the practical issues trainees and their managers might want to consider before setting up an advanced nursing practice service in their hospitals.
Keywords
Aspiration, bone marrow biopsy, training
Every year in Europe about 230,000 people are diagnosed with a haematological malignancy such as leukaemia, lymphoma or myeloma (Rodriguez-Abrue et al 2007). Most patients routinely undergo bone marrow biopsies, which enables a diagnosis to be made, stage of the illness to be accurately assessed and the effectiveness of treatment to be evaluated.
A bone marrow biopsy removes haematopoietic tissue from the medullary cavity of the bone and usually involves two separate, but interrelated, procedures.
The first is an aspiration of the marrow, a liquid sample, to provide a specimen for cytological analysis (Perkins 2003), which is smeared on to a glass slide, stained and examined under a microscope by haematologists. An array of cytogenetic, molecular and flow cytometric tests can also be carried out on cells in liquid suspension. If performed correctly, a bone marrow aspiration is simple and safe; it can be repeated many times and performed in an outpatient setting (Lewis et al 2006).
The second specimen is a trephine, or core, biopsy of the bone and associated marrow (Longo 2005). This is invaluable in diagnosing conditions that yield a 'dry tap' on bone marrow aspiration, such as myelofibrosis, infiltrative processes, or when disrupted architecture of the marrow cells is an important diagnostic feature, for example with Hodgkin lymphoma. The trephine is decalcified in the laboratory before being sliced and mounted on a glass slide for examination and reporting by haematologists. It is often performed in an outpatient setting (Lewis et al 2006).
Bone marrow biopsies are not only used in the haematology setting. Increasingly, they are performed...