Regenexx Blog
Dr. Chris Centeno

I'm down in the Bahamas lecturing, and as a result, I wanted to share what I’ve been teaching other physicians about stem cell harvesting techniques. My lecture this morning is specifically on how to maximize the number of stem cells that can be obtained from a BMA procedure. Below I’ll discuss questions that patients can ask doctors to see if they are stem cell experts or novices.

Click for video:

What Is a BMA and How Can That Tell Me if My Doctor Is a Stem Cell Expert or Novice?

A BMA, or bone marrow aspiration, is a procedure where a doctor takes a small sample of the liquid portion of the bone marrow, called an “aspirate.” The doctor will use a machine or a lab to extract a cell fraction that is rich in stem cells. So the better your doctor is at the procedure, the more stem cells you’ll have. The more cells you have, in general, the bigger dose of stem cells you’ll get and the greater chance you’ll have of the procedure being effective. If your doctor does this procedure poorly, you’ll have fewer cells and will get a smaller dose of stem cells.

The Questions to Ask Your Doctor

The video above goes into much detail, and while the slides are aimed at a physician audience, the narration is aimed at a patient audience. From the video, here are the things you should ask your doctor, to see if he or she is performing this procedure to maximize your stem cell yield:

Do you take bone marrow from multiple sites or just one or two sites? If your doctor only uses 1–2 sites, the number of stem cells will be reduced.

However, if he or she plans to take bone marrow from 3–5 sites per side (6–10 sites total), then this will maximize the number of stem cells obtained in the procedure.

Do you use either ultrasound or fluoroscopy (real-time X-ray) guidance to perform the procedure, or do you perform it blind? If your doctor doesn’t plan on using guidance, this will increase the likelihood that he or she takes cells from the wrong spots, reducing the number of stem cells. In 2016, it’s standard of care to perform a BMA procedure with either ultrasound or fluoroscopy guidance!

Do you adjust the volume of bone marrow you harvest based on which joint you’re treating and my size, or do you always take the same amount? It would seem to be common sense that older patients have fewer stem cells, and as such, your doctor would want to take a bit more bone marrow to compensate. In addition, it would also make sense that treating a larger joint, like the knees, or treating two large joints would require more stem cells than treating a single smaller joint. All of this will require your doctor to adjust the amount of bone marrow either up or down. However, if your doctor says he or she always takes the same amount, this is an indication that the doctor is using a “one size fits all” approach. This makes little sense, as experienced physicians doing this work will adjust the amount of bone marrow they take to fit the patient’s needs.

Where do you take bone marrow from? The back of the hip at the PSIS, the front of the hip at the ASIS, or the knee (tibia)? The research that we have shows that there are more stem cells to be had at the PSIS (back of the hip area near the dimples of Venus) than at the ASIS (front of the hip) or the knee (tibia). Hence, if your doctor has plans to draw from any other site, this may reduce the number of stem cells he or she can harvest.

The upshot? At the end of the day, an educated patient generally receives better medical care than one who hasn’t done his or her homework. While all doctors performing stem cell treatments may look the same, they’re not the same. When it comes to a bone marrow aspiration procedure, few do this right to maximize your chances of success. So take a few minutes and ask your doctor (or the doctor’s assistant) these four simple questions to help determine if he or she is a stem cell expert or novice. If the doctor is not doing everything shown to maximize the number of stem cells, then find another doctor! All Regenexx-trained physicians follow all of the rules to maximize stem cells! For a list of those expert stem cell doctors, click here…