Biopsy needles and gun Kidney Biopsy : indications, procedure, contraindications and complications Liver Biopsy : indications, procedure, contraindications and complications Bone Marrow Biopsy and Aspiration : indications, procedure, contraindications and complications

1. Kidney, Liver & Bone marrow
Biopsy
Dr Abdullah Ansari
Senior Resident
Department of Medicine
Aligarh Muslim University

2. Jamshidi bone marrow biopsy needle

3. Spring loaded biopsy gun

4. Trucut biopsy needle

5. Kidney biopsy

6. Indications
• Nephrotic range proteinuria
• Nephritic syndrome
• Rapidly progressive renal failure
• Unexplained renal failure
• Renal transplant rejection
• Systemic diseases involving kidneys: SLE, vasculitis, myeloma

7. Procedure
• Per-cutaneous approach
“Real time” under USG guidance
Patient position : prone
Preferred site : lower pole of left kidney
• Trans-jugular approach

9. Contraindications
• Uncontrolled coagulopathy
• Uncontrolled hypertension
• Shrunken kidney
• Solitary kidney
• Bilateral multiple kidney cysts
• Suspected malignancy
• Hydronephrosis
• Active infection

10. Complications
• Bleeding
Collecting system: hematuria
Within renal capsule: pain
Peri-renal space: hematoma
• Pain : ureteral obstruction by blood clots
• Arteriovenous fistula
• Page kidney
• Peri-renal infection
• Puncture of adjacent organs: colon

11. Liver biopsy

12. Indications
• Unexplained liver biochemistries
• Confirmation of diagnosis and prognostication, eg assessment of
inflammation and fibrosis in chronic hepatitis C
• Suspected liver malignancy
• Diagnosis of cholestatic diseases
• Diagnosis of infiltrative/granulomatous disease
• Liver transplant rejection

13. Procedure
• Percutaneous approach
Patient position : supine with right arm behind head
Site : right lateral chest wall, usually 8th ICS
Confirmed by percussion or USG
• Trans-jugular approach

16. Contraindications
• Coagulopathy
• Thrombocytopenia
• Gross ascites

17. Complications
• Pain
• Bleeding
• GB puncture: bile peritonitis
• Pneumothorax
• Sepsis/abscess
• Inadvertent kidney biopsy

18. Bone marrow biopsy & aspiration

19. Indications
• Diagnosis, staging and therapeutic monitoring of lymphoproliferative
disorders: leukemia, lymphoma, myeloma
• Pancytopenia
• Unexplained anemia, leucocytosis, thrombocytosis
• Diagnosis of infiltrative infections: fungal, tuberculosis,
granulomatous
• Diagnosis of storage disorders: Niemann Pick’s, Gaucher’s
• Determining marrow damage on exposure to radiation, drugs,
chemicals

20. Procedure
Sites
• Posterior iliac crest: preferred site
• Anterior iliac crest
• Sternum
• Tibia

22. Contraindications
• Uncooperative patientt
• Infection/Radiation therapy at biopsy site
Thrombocytopenia is not a contraindication
Coagulopathy corrected by FFP transfusion

23. Complications
• Bleeding
• Infections
• Needle breakage

24. Thank you