Clinical Class Presentation

1. B o n e M a r r o w Aspiration
By Dr Sahana Shankari
Senior ResidentS
Department of Kaumarabhritya
FoAy,IMS BHU, Varanasi

2. Definition
• Bone Marrow aspiration is the removal of fluid from
the soft, spongy material that lines inside of bones by
suction
• Bone marrow biopsy is the removal of a small piece of
bone marrow

3. Indications of BMA
• Diagnosis of sever anaemia, pancytopenia, unexplained
thrombocytopenia, leucocytosis
• Hypoplastic, Aplastic,Megaloblastic,sideroblastic Anaemia
• Lymphoreticular Malignancy,Langerhans’ cell histiocytosis,
hemophagocytosis syndrome
• Infiltrative storage disorders Eg: Gaucher’s Disease
• Infections involving the bone marrow,
• : Eg T.B (Acid Fast bacilli), Kala -azar (LD bodies)
• Leukemia,Lymphoma
• To evaluate Suspected metastasis
• For bone marrow Transplantation
• To rule out leukemia from ITP

4. Indications of Bone Marrow
Biopsy
• To obtain intact bone barrow for making the diagnosis
of hematological malignancy or anaemia
• To diagnose fibrosis of bone marrow and myeloma
when bone marrow aspiration has failed
• Two procedures are used together to get the best
specimen

5. Contraindications
• Local infection

6. Equipment
• Bone marrow aspiration and biopsy needles consist
of 3 parts
• Needle : stout wide bore needle of 5cm length .
• Shortly beveled at one end and the base of the stylet
fits in the other broad end
• Stylet : It keeps the needle patent during introduction,
the base contains a small projection for better
protection of the needle
• Adjustable guard : prevents over penetration of the
needle

7. Jamshidi
needle
• Tapering end to reduce crush
artefact

8. • Islam's bone marrow aspiration
needle: the dome-shaped
handle and the T-bar are
intended to provide stability and
control during the operation
• Disposable bone marrow
aspiration needles

9. • Most common reusable needles:
Klima and Salah
• Point of the needle and the edge
of the bevel must be kept well
sharpened

14. Procedure
• Place the patient in the prone position with a
pillow elevating the pelvis during aspiration from
posterior iliac crest. Adults may lie in lateral
position
• Skin covering the biopsy site is cleaned with spirit-
povidine iodine-sprit
• Midazolam (0.1mg/kg) and ketamine (1mg)/kg)
are administered by slow IV followed by
administration of local anaesthetic
• The needle is inserted with steady pressure in a
boring motion perpendicular to the surface of the
bone.
• The needle should enter the ilium at the posterior
superior iliac spine , which is the visible and
palpable bony prominence superior and lateral to
the intergluteal cleft
• Once the needle enters the cortex there is a “give
away” feeling.
• The needle is firmly anchored in the bone.

15. • The stylet is removed and marrow is aspirated
with 20ml syringe.
• Less than 2ml of marrow is aspirated by a
syringe attached to the needle. If more
marrow is needed needle is repositioned
slightly, a new syringe attached and a second
sample is taken
• Pressure is applied locally after the needle is
removed
• Samples are transferred quickly from the
syringes to slides and sent to the lab for
analysis. There is no need to add anticoagulant
accept for the immunophenotyping in which
case the aspirate is put in a vacutainer
containing EDTA

16. Preparing films from
BoneMarrow Aspirates
• Smears should be made
without delay
• Smear length: 3-5cm
• Glass spreader: smooth
edged, not more than 2cm
width
• Marrow fragments
dragged behind the
spreader
• Fragments leave a trail of
cells behind them
• Spreading should be
towards the label area.

17. Processing of
marrow
Aspirates

18. Causes of Dry tap
• Marrow Aplasia
• Myelofibrosis
• Faulty technique

19. Procedure of Bone Marrow
Biopsy
• Preferably done before aspiration
• Site prepared as above
• The Procedure is done with a biopsy needle
• The Needle and stylet are inserted; the stylet is then
removed.
• The needle is then rotated to the right then to left
withdrawn slightly and reinserted at a different angle.
• The procedure is repeated until a small chip is
separated from the bone marrow.
• The needle is removed and a piece of fine wire
threaded through its tip transfers the specimen onto
vial containing formalin.
• After the needle is remove the biopsy site should be
covered a clean dry dressing
• Pressure is applied to control the bleeding

20. Monitoring
• Pulse rate, RR, BP, Temperature- till return to normal,
patient is instructed to lie on back for half an hour
• Biopsy site should be covered for several hours
• Report immediately
• Pain >24 hrs after procedure,
• Temperature >101F
• Bleeding more than few drops of blood on wound
dressing

21. • Generally a safe procedure
• Serious adverse events<0.05% of
procedures
• Most common complication:
bleeding
•Local pain
•Osteomyelitis
• Gluteal compartment syndrome
• Very rarely death
• Bleeding is related to impairment of
platelet function than to
thrombocytopenia or a coagulation
factor defect
Complications

22. References
• Ghai Essential Pediatrics, Vinod K.Poul,Arvind
Bagga,CBS Publishers &Distributers,9th Edition,Page No
743-744
• Pediatric Procedures,Rakesh Lodha, SK Kabra,
Bagga,CBS Publishers &Distributers, First Edition,Page
No 130-134
• Google images