Bone marrow aspiration and biopsy

• Bone marrow examination is useful in the

diagnosis of hematologic disease and
• To asses over all bone marrow cellularity.
Indication
• Pancytopenia
• Myelodysplasia
• Myeloproliferative disease
• Non-Hodgkin or Hodgkin
lymphoma
• Childhood solid tumors
• Bone marrow failure
• Fever of unknown origin
• Storage disease
17
 Indication cont…
Aspiration only
• Unexplained anemia, leukopenia, or
thrombocytopenia
• Monitoring during chemotherapy or following
stem cell transplantation
• Acute or chronic leukemia
CONTRAINDICATIONS
Relative
• Congenital factor deficiency or acquired
coagulation defect
• Anticoagulation with warfarin or heparin
• Severe thrombocytopenia
• Infection or prior radiation at sample site

18
 Contraindication con….
Absolute
• Hemophilia,
• DIC, or other related severe bleeding disorders
• Supected multiple myeloma & other disorders
resulting in bone resorption (Contraindications only
for sternal BM aspiration)
 Equipment

• Sodium heparin, injection, 1000 USP units/mL,

preservative free.
• Bone marrow aspiration needles (15 and 18 gauge,
adjustable lengths).
• Bone marrow biopsy needles (11 and 13 gauge, 4 or
2 inches in length).
• Sterile syringes, 10 to 20 mL.
• Container with fixative for trephine biopsy
specimen.
• Vacutainers; one for sodium heparin and one
for ethylenediaminetetraacetic acid (EDTA).
• Gauze sponges.
• Bandages.
 Complications
• Bleeding at any site, with or without
development of a hematoma
• Osteomyelitis
• Infection (rare)
• Needle breakage
• Other rare
transient neuropathy,
tumour seeding & others

21
 Intraosseos infusion
Is the process of injecting directly into the marrow
of a bone to provide a non collapsible entry point
into the systemic venous system.
• Used in emergency situations when
intravenous access is not available or not
feasible

6
 INDICATIONS
■ Emergent temporary vascular access during
cardiopulmonary
resuscitation or during the treatment of
uncompensated
shock when unable to insert an intravenous line.
■ Volume resuscitation.
■ Administration of blood and blood products.

7
 Indication cont…
■ Administration of fluids and electrolytes.
■ Administration of medications.
■ Infusion of inotropes and pressors.
■ Sampling of blood and bone marrow.
 Contraindications
Absolute
■ Do not insert in a recently fractured bone.
■ Do not insert through an infected site.
■ Osteogenesis imperfecta.
■ Osteopetrosis.
Relative
■ Osteoporosis or osteopenia.
■ Cystic bones.

8
 Equipment

■ Intraosseous needle (18 or 20 gauge) or bone

marrow
aspiration needle.
■ Povidone, chlorhexidine, and alcohol wipes.
■ Gauze.
■ Tape.
■ Extension tubing.
■ T-connector.
■ Syringe.
■ Gloves
9
 Risks
■ Infection
Injury to growth plate.
■ Bone fracture.
■ Hematoma.
■ Extravasation.
■ Compartment syndrome.
■ Severe vasoconstriction if vasoactive substances
extravasate.

10