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Subject: Bone Marrow Biopsy
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Bone marrow biopsy needle
Sterile collection tubes for both aspirate and marrow biopsy
Scalpel blade size no. 10 or 15
Unexplained anemia—can determine both iron stores and underlying etiology
Lymphoma and leukemia diagnosis, staging, and response to treatment
Evaluation of cytopenias
Bone marrow transplant
Immunocompromised states, to evaluate for infection or white cell line deficiencies
Thrombocytopenia, to assist in differentiation of bone marrow disorders from splenic sequestration and increased peripheral platelet destruction
Infection, particularly fungal and tubercular infections
Fever of unknown origin, to evaluate for malignancy or infection
Thrombocytopenia—platelet levels of <20,000 to 50,000 usually require platelet transfusion prior to invasive procedure. Assistance from a hematologist or other qualified specialist is advised in this situation.
Severe osteoporosis—evaluate for risk of fracture due to procedure.
Previous radiation at the site—marrow site may be sclerotic and may not provide good sample material.
Infection or osteomyelitis at or near the puncture site.
PITFALL: Medical personnel with expertise in the use of conscious sedation should be present.
Pearl: The use of conscious sedation with intravenous propofol, midazolam, and fentanyl has been studied in the outpatient setting. This conscious sedation is in addition to local anesthesia. The use of conscious sedation has been shown to be as safe as using local anesthesia alone.
Pearl: The use of oral premedication may be helpful in some patients.
Pearl: The amount of pressure required often requires the full use of upper body strength rather than just arm strength (as with chest compressions during cardiopulmonary resuscitation).
PITFALL: If the needle is not angled correctly, it may slip down the iliac crest and not enter the marrow cavity.
PITFALL: The aspiration process is painful. Warn the patient before the actual aspiration is performed.
PITFALL: If no marrow is aspirated, replace the obturator and advance the needle 1 to 2 more mm and attempt aspiration again.
PITFALL: If the needle is advanced without the obturator in place it may become clogged with bony material.
Pearl: If no marrow is obtained, then change biopsy sites.
Pearl: This forward motion within the marrow cavity should be performed with the same clockwise and counterclockwise rotation used to penetrate the bony cortex.
PITFALL: Do not replace the obturator until the needle is fully withdrawn.
The bone marrow needle can break and must be retrieved with either a hemostat or with the assistance of a surgeon.
Hemorrhage may occur at the biopsy site and is treated with local pressure at the biopsy site. (This is more of a risk in patients with thrombocytopenia.)
Retroperitoneal hematoma from bleeding complication.
Pulmonary emboli can occur after sternal aspiration.
Infection of bone marrow aspiration sites. (This is more of a risk in immunocompromised patients.)
Fracture of bone.