Trephine biopsy of the bone marrow.

We present a review of trephine biopsy of the bone marrow based on an experience of approximately 10 000 examinations. It is our view that, in adults, examination of material obtained by aspiration combined with a trephine biopsy allows for the most thorough morphological assessment of the marrow. Morbidity is limited to transient discomfort to the patient, and even bilateral procedures are conveniently performed on outpatients. There is no absolute contraindication to combining aspiration and trephine biopsy, but in severe bleeding disorders due to acquired or congenital coagulation factor deficiencies replacement therapy is indicated and the patient should be observed in hospital for 24 hours following the procedure. Thrombocytopenia is not associated with significant bleeding from the biopsy site in our experience. The advantages of the trephine biopsy are that it allows better overall assessment of cellularity and morphology and is indispensable in cases where aspiration has failed or where infiltration due to the myeloproliferative syndrome or to haematological and non-haematological malignancies has occurred. With marrow hypoplasia and granulomatous disorders involving the marrow, the trephine biopsy is indispensable for diagnosis.