Bone marrow aspiration is a procedure where a small bone marrow sample is removed, usually from the hip, breastbone, or thigh bone. A local anesthetic is used to numb the skin and bone before a needle is inserted to aspirate (remove) a liquid bone marrow sample. The sample is examined under a microscope to diagnose diseases of the bone marrow or blood cells. Common reasons for the procedure include diagnosing anemia, leukemia, lymphoma, or monitoring treatment effectiveness. The posterior iliac crest is typically the preferred site but other sites like the sternum or tibia may also be used depending on the patient's age. Precautions are taken to properly prepare, perform, and monitor the patient after the minimally invasive
2. Introduction
A procedure in which a small sample of bone marrow is removed, usually from
the hip bone, breastbone, or thigh bone. A small area of skin and the surface of
the bone underneath are numbed with an anesthetic. Then, a special wide
needle is pushed into the bone. A sample of liquid bone marrow is removed with
a syringe attached to the needle. The bone marrow is sent to a laboratory to be
looked at under a microscope. This procedure may be done at the same time as
a bone marrow biopsy.
3.
4. Why Bone marrow?
Doctor may perform a bone marrow exam to:
• Diagnose a disease or condition involving the bone marrow or
blood cells
• Determine the stage or progression of a disease
• Determine whether iron levels are adequate
• Monitor treatment of a disease
• Investigate a fever of unknown origin
5. Indications
• Anemia.
• Hemochromatosis (iron overload).
• Leukemia.
• Myelodysplastic syndrome.
• Aplastic anemia.
• Leukopenia, a condition that causes low white blood cell count.
• Lymphoma, including adult Hodgkin’s lymphoma and adult
non-Hodgkin’s lymphoma.
• Myelofibrosis.
• Tuberculosis.
6. • Bone Marrow Aspiration is an invasive procedures in
which good technical skill is crucial to obtain samples suitable
for processing and diagnostic interpretation. The type and
calibre of the needle is one of the main variables of the
technique, and is selected on the basis of the age, gender and
body mass of the patient.
7. A bone marrow kit
A bone marrow kit should be utilized containing:
• Sterile drapes
• Needles
• Syringes
• An aspiration needle
• A biopsy needle. If performed on the posterior iliac crest, a Jamshidi needle is often
preferred for biopsy.[15]
• 1% to 2% lidocaine with or without epinephrine
• Specimen slides
• Specimen containers will be required as well. The number of required pathology slides
and specimen containers will vary depending on the type of pathology under investigation
and whether or not a biopsy will be performed in addition to the aspiration.
9. Sites of Bone marrow Aspiration and Biopsy
The site selected for the aspiration
depends on:
The age of the patient
Whether or not a needle or
trephine biopsy is required
The appropriate sites in an adult
include the posterior iliac crest
(preferred site), anterior iliac crest,
and sternum.
Under 12 years – iliac crest
The tibia may be used in infants
younger than 18 months of age.
9
10. The sternum
The best site when aspiration only is needed
The easiest to puncture
Considered to yield the most cellular samples
A disadvantage is that the patient has a clear view of the procedure
which may cause distress
Anterior or posterior iliac spines
Have the advantage that if no material is aspirated, a micro trephine
biopsy can be performed immediately
In disorders associated with replacement of hemopoietic marrow
by other tissues or cells(e.g., malignancies in the bone marrow)
Marrow aspiration may be difficult or impossible, the so-called dry
tap
In such cases, a needle or trephine biopsy is essential
10
11. Bone marrow from the superior
part of the posterior iliac spine
(back of the hipbone) 11
12.
13. Infants and children: the sternum is naturally thin and an
alternative site is preferred
Under 12 years – iliac crest
Under 2 years – the presence of active marrow in the long
bones makes the proximal anterior portion of the tibia a
possible site
In disorders associated with replacement of hemopoietic
marrow by other tissues or cells (e.g., malignancies in the bone
marrow)
Marrow aspiration may be difficult or impossible, the so-
called dry tap
In such cases, a needle or trephine biopsy is essential
13
14. A minimum amount of marrow should be aspirated
Volumes over 0.5ml will almost certainly be diluted with
blood making processing and interpretation more difficult
Careful preparation is essential
It is desirable, if possible, to concentrate the marrow cells at
the expense of the blood in which they are diluted
14
15. Preparations prior to the procedure
The procedure should be explained in detail to the patient.
The past clinical history of the patient should be obtained
Informed consent should be obtained from the patient.
A blood count and smear should be obtained
Adequate sedation and analgesia determined
Assessment of thrombocytopenia or coagulopathic risks
Consider site for BM examination carefully
15
16. Procedure for Bone marrow aspiration
Patient preparations should be ensured.
A needle is inserted in to the iliac crest or spine
The needle and stylet are pushed into the bone with a slight
rotary motion.
When it is felt that the needle is firmly in place, the stylet is
removed and a syringe with out anticoagulant is attached and
<0.5ml of bone marrow and blood aspirated.
Bone marrow smears should be prepared immediately
following aspiration.
16
17. Procedure for Bone marrow aspiration…
A second syringe should be attached to the aspiration needle to
draw additional samples for supplementary tests, such as
Flow cytometry,
Cytogenetic analysis and Molecular genetic studies,
microbiology, Electron microscopy or BM culture.
In the event of a ‘dry tap’, or if no particles (‘fragments’) have
been obtained, the BM aspirate can be repeated at a slightly
different angle or at another site.
17
18. Nursing Interventions
1.Nursing responsibilities include preparing and educating the patient, assessing
him for complications, supporting him during the procedure, and assisting the
practitioner.
2.After aspiration, apply direct pressure over the puncture site for 5-10 minutes
until bleeding stops
3.Help the patient to a comfortable position
4.Clean the puncture site and apply a sterile dressing.
5.Monitor the patient’s vital signs and the puncture site for signs and symptoms
of infection.
The sternum
The best site when aspiration only is needed
The easiest to puncture
Considered to yield the most cellular samples
A disadvantage is that the patient has a clear view of the procedure which may cause distress
Anterior or posterior iliac spines
Have the advantage that if no material is aspirated, a micro trephine biopsy can be performed immediately