骨髓穿刺及活检 中国就医指南

Bone marrow aspiration and biopsy is a diagnostic medical procedure—not a disease—commonly performed in the Department of Hematology to evaluate hematopoietic function, detect blood disorders, and assess bone marrow involvement in systemic conditions. It involves two complementary techniques: aspiration (withdrawal of liquid marrow using a needle) and biopsy (removal of a small core of solid marrow tissue), typically conducted from the posterior iliac crest under local anesthesia. The procedure is essential for diagnosing and staging hematologic malignancies—including leukemias, lymphomas, multiple myeloma, and myelodysplastic syndromes—as well as evaluating unexplained cytopenias (anemia, neutropenia, thrombocytopenia), pancytopenia, suspected metastatic cancer, storage disorders (e.g., Gaucher disease), and infections such as tuberculosis or fungal myelitis. Pathogenesis relevance lies not in the procedure itself but in its role to uncover underlying pathophysiologic mechanisms—such as clonal hematopoiesis, marrow infiltration, fibrosis, dysplasia, or hypocellularity—that drive clinical hematologic dysfunction. Epidemiologically, the procedure is routinely indicated across all age groups but most frequently in adults aged 50–75 years, reflecting the higher incidence of hematologic cancers and age-related marrow changes. In China, over 200,000 bone marrow examinations are performed annually in tertiary hospitals, with rising demand driven by improved diagnostics, aging population, and expanded screening for early hematologic neoplasms. Key risk factors prompting referral include persistent fatigue, recurrent infections, unexplained bruising or bleeding, night sweats, weight loss, lymphadenopathy, hepatosplenomegaly, and abnormal peripheral blood counts on routine CBC. While the procedure itself carries low morbidity—minor pain, transient bleeding, or localized infection in <2% of cases—the psychological burden, procedural anxiety, and delays in definitive diagnosis can significantly impair quality of life. Patients often experience anticipatory distress, fear of malignancy, and disruption in daily functioning during the diagnostic odyssey; those with chronic hematologic conditions may face repeated aspirations over time, compounding emotional and physical strain. Importantly, timely and accurate bone marrow evaluation directly informs prognosis, therapeutic selection (e.g., chemotherapy vs. targeted therapy vs. transplant), and monitoring response—making it a cornerstone of precision hematology care.

# 骨髓穿刺及活检治疗方案与费用明细（血液科）

一、非手术/保守诊疗方案

适用于初筛、随访、排除血液系统疾病者：

• •骨髓穿刺术（单次）：含局部麻醉、穿刺操作、涂片制备与形态学初报；适用人群：疑似贫血、血小板减少、白细胞异常者。

• •骨髓活检+组织病理+免疫组化（全套）：含石蜡切片、HE染色、CD34/CD61等3项免疫组化；适用人群：需明确骨髓纤维化、淋巴瘤浸润或MDS诊断者。

二、手术/核心介入方案

属血液科常规有创诊断操作，非根治性手术，但为确诊金标准：

• •联合穿刺+活检（同步完成）：同一穿刺点行抽吸+活检，提升诊断率；适用人群：初诊AML、MM、骨髓增殖性肿瘤患者。

- 全套操作费（含超声引导、双标本处理、流式细胞学送检）：4,200–6,800元

三、特殊复杂情况方案

• •多次穿刺失败、骨髓干抽、严重凝血障碍者：加行髂骨CT引导下穿刺或胸骨穿刺，费用上浮1,500–2,200元；合并感染/出血并发症者，需住院监护及止血治疗，额外费用3,000–8,000元/疗程。

四、方案快速选择指南

• •预算≤1,500元/次：选单纯骨髓穿刺（初筛贫血、ITP）；
• •需明确分型/预后分层：选联合穿刺+活检+免疫组化（推荐三甲血液科）；
• •反复干抽或高龄凝血异常者：优先CT引导穿刺，避免盲目重复操作。