Taming the Stem Cell Wild West: Bone Marrow Aspiration
POSTED ON IN Regenerative Medicine Education BY Christopher Centeno
We've been taking bone marrow aspirates (BMA) for orthopedic stem cell treatments for a decade. In that time, we've done many thousands and have learned a thing or two. Despite what we've learned and what others have published on how to do this, we still see doctors taking weekend stem cell courses that are totally confused on how to do this procedure correctly to maximize the number of stem cells obtained. This morning I'd like to go through our research and the literature to review what we know and dispel the myths of the stem cell wild west.
I really think the disconnect between the reality of how to get the best yield for the patient from a BMA and the many myths out there began when a bevy of physicians who really weren't experts in this area began offering their teaching services to bedside bone marrow machine manufacturers. The thing that these physicians had in common is that they had never been in a situation where the number of stem cells that was in the final aspirate were counted or mattered. Hence, without this constant feedback (Mrs. Smith had a low yield and Mr. Jones had a high one), they began to develop bone marrow aspiration techniques based on convenience. One example that's really nutty is what I called the "high volume draw". As you'll see from the video above, we've known since the 1990s that only using one or two bone marrow draw sites and drawing higher volumes was a sure fire way to guarantee the patient a poor stem cell yield. However, to draw less sites takes less time for the physician and without any feedback on what's in the bone marrow, you can see why some doctor decided to do it this way and then teach it to others.
The second category of BMA myth seems to have been created by some understanding of where stem cells live, but without any significant testing to ensure that it's really a technique that produces better yield. Case in point is a technique where the physician takes small samples of marrow as the trocar is moved through the bone. There isn't any data that I can find that shows that this helps to improve yield. As shown in the video, the procedure also doesn't have much face validity (i.e. a simple explanation of why it would get more cells).
The upshot? BMA myths abound, so hopefully this video dispels the myths and allows physicians to pull more cells. Now pulling more cells out of the bone marrow is only half the battle, the other half is a processing technique that maximizes the number of stem cells in the final injection. For that second part, if the doctor puts this stuff in bedside centrifuge, there will be fewer stem cells per cc than in a Regenexx procedure, but at least more cells went into the machine using these common sense techniques than the weekend course method!
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