Bone marrow aspiration and biopsy are procedures used to examine bone marrow and diagnose blood disorders. Bone marrow aspiration involves inserting a special needle into the bone marrow to obtain a tissue sample. Bone marrow biopsy involves removing a small core of bone marrow using a rotating needle. The posterior iliac crest is the most common site used. Bone marrow samples are examined under a microscope to identify blood cell components and detect any abnormalities that help diagnose conditions like leukemia, lymphoma, and myeloma. Nurses play an important role in preparing equipment, assisting during the procedure, and monitoring the patient afterwards.

1. BONE MARROW EXAMINATION
P SUNIL KUMAR
Haematology & Transfusion Medicine
ST.JOHN’S MEDICAL COLLEGE
BANGALORE10/13/2018 1SUNIL KUMAR P

2. • 1.BMA
• 2.BM Bx
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3. BONE MARROW ASPIRATION
DEFINITION
• BMA ..Is a procedure performed by the doctor
where a special needle is inserted into the
bone marrow to obtain bone marrow tissue
specimen.
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4. TREPHINE BIOPSY
• Removal of a small core of BM under local
anesthetic.
• It is used to assess BM structure, the no. &
distribution of all types of blood cell .
• Trephine biopsy is 1-2cm long 2-3mm in dia.
Of the marrow containing bone taken by
rotating specialized needle under pressure
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5. TREPHINE BIOPSY Needle
• Jamshidi Needle
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6. SITES OF TREPHINE BIOPSY
• Posterior superior iliac spine ( Most common)
• Anterior superior iliac spine
• Spinous process of vertebra
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7. Indications of Trephine Biopsy
• 1.Aplastic anaemia
• 2.MPN- to study reticulin fibrosis in
myelofibrosis
• 3.MDS
• 4.Pre- and Post –bone marrow transplantation
• 5.Pyrexia of unknown origin
• 6.Staging – Lymphoma
• 7.To detect metastis in cancer
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8. Cells which are studied…..
• Erythrocytes
• Leukocytes
• Thrombocytes
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9. Indication for B M aspiration
• 1. Diagnostic
• 2. Systemic diseases
• 3.Staging of lymphoid malignancies and solid
tumors
• 4. Detection of infection
• 5. Iron stores
• 6.Miscellaneous disorders : Eg; pancytopenia
• 7.Post treatment follow up
• 8.Therapeutic : BM transplant
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10. Indication for B M aspiration
• Diagnostic
• 1. Primary hematolymphoid disorders
• A. Red cell disorders : Eg; Megaloblastic anaemia, pure
red cell aplasia.
• B.White cell disorders : Eg; Leukaemias , diagnosis and
classification of acute leukaemias.
• C. Megakaryocytic disorders : ITP & other
thrombocytopenia's
• D. Myeloproliferative neoplasm's: PV, CML
• E. MDS
• F. Plasma cell neoplasm's.
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11. Indication for B M aspiration
• Systemic diseases :
• A. storage disorders : Gaucher disease
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12. • Staging of lymphoid malignancies and solid
tumors
• A. Lymphoma
• B. Metastatic deposit ( Prostate, Kidney, Lung)
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13. • Detection of infection
• A. parasitic : Eg; kala –azar
• B.Fungal : Histoplasma
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14. BMA
• Needles commonly employed for the
aspiration of the marrow are
• 1. Salah needle
• 2.Klima needle
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18. BMA
• Parts o the BMA needle :
• Stilette : Prevent the entry of soft tissue and
bone fragments into the aspiration needle
when it pierces through them.
• Aspiration needle : For aspirating the marrow,
a syringe is attached after removing the
stilette.
• Guard: it adjusts the depth of penetration of
the aspiration needle
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19. Sites of BM Aspirate
• Usual sites for BMA are
• 1. Sternum (2nd space of sternum)
• 2.Posterior superior iliac spine
• 3. Iliac crest
• 4.Anterior superior iliac spine
• 5.Spinous process of lumbar vertebra
• In infants, upper end of the tibia is the ideal
site for marrow aspirate
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21. Possible complications
• Infection
• Bleeding
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22. Risk factors for complication
• Bleeding disorders
• Infection of the skin overlying the area from
which the biopsy is to be taken
• Infection in the bloodstream
• Severe osteoporosis
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23. Assessment
• Check doctor’s order in progress note:
• Right client
• Selected site for procedure
• Any pre-medication order
• Check for consent form is sign by doctor and
client.
• Assess client’s:
• Level of consciousness or restless
• Ability to assume position required for
• procedure.
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24. • Skin of procedure site
• Vital sign
• Notify for lab Technician on call
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25. PREPARATION
• Second nurse as assistant
• Lab technician with glass slide
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26. EQUIPMENTS
• Carbolised tray
• Big tray with:
• Disposable dressing set
• Extra cotton balls and gauzes
• 1 pair of sterile gloves
• Face mask
• 1 Fenestrated towel
• Bone marrow aspiration needle with inner stilette
• Cleansing solution (surgical spirit 70% and
• povidone iodine
• Glass slide and Glass marking pencile
• Formalin ( 10%) fixative for BM Bx
• EDTA and Na Heparin Tubes
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27. EQUIPMENTS
• Lignocaine 1% or 2%
• Syringes: 3ml×2, 5ml×2 and 20ml×2
• Needles: 18G×2 and 23G×2
• Heparin saline 5ml×2
• Elastoplast
• Medication tray with prepared pre-medication
drugs.
• Laboratory form according to type of test.
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29. IMPLEMENTATION
• Wash hand.
• Greet client and check ID tag.
• Explain procedure.
• Provide privacy.
• Adjust bed.
• Second nurse position client according to doctor’s
chosen site for procedure.
• Expose insertion site and place incopad
underneath.
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30. • 1st nurse assist :
• The doctor throughout procedure
• Open dressing set follow by all sterile items as
per requirement needs.
• Pour solution
• Give assistant to doctor when necessary
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31. • 2nd nurse
• Observe client’s condition for difficulty in
breathing or unbearable pain throughout the
procedure.
• Maintain client in supine position and check
client’s vital sign hourly for 4 hours.
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32. • Make client comfort.
• Put up both cot side and place call bell within
the client’s reach.
• Cleat trolley and wash hands.
• Document in nursing care plan.
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33. PROCEDURE
• Ask the patient to lie down in prone position or side wise
(left or right lateral).
• Disinfect the area with the disinfectant. (large area of skin
at the site of procedure
• Infiltrate the skin, subcutaneous tissue and periosteum
overlaying the selected site with local anesthesia.
• Needle inserted in skin through the subcutaneous tissue
through cortex of the bone, which is sensed by a decreased
resistant to the forward movement of the needle
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34. • The obturator is then removed and the needle is slowly advanced with
reciprocal, clockwise-counterclockwise twisting motions around the long
axis.
• After sufficient penetration of bone , the needle is rotated several times in
its axis and withdraw about (2-3mm).
• The needle is slowly withdrawn using the same twisting motion employed
during insertion.
• The core of marrow inside the needle is removed by inserting the probe
through the cutting tip and extruding the specimen through the hub of the
needle.
• Make touch preparation before fixing the specimen in 95% Zenker’s fluid
or 10% formal saline.
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39. MICROSCOPIC
EXAMINATION OF
BMA
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41. • Others :
• Metastatic tumor cells, parasites, and fungus.
• Iron Stores:
• Iron stores are evaluated by Prussian blue
reaction .
• Iron stores are commented as normal/
abnormal/ increased/ decreased / nil.
• Cyto chemistry / special stains
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42. NURSING
RESPONSIBILITY
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43. BEFORE…..
• Physical preparation
• Make sure the doctor have obtain consent
from client
• Provide clear explanation
• Make sure the puncture site has been cleaned
• check vital sign.
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44. • Prepare equipments
• Prepare trolley aseptically
• Make sure equipments are complete
• Make sure laboratory technicians has been
inform more earlier.( Technician must be
present during procedure because aspirated
bone marrow is smeared immediately on a
glass slide.)
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45. DURING…….
• Help client to remain in the right position
• Assist the doctor in the procedure. ( Prepare
the equipments and hold the client)
• Monitor vital signs during procedure to
dectect complication.
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46. AFTER
• Place the client in supine position and apply
sandbag at the puncture site at least for 6
hours to prevent bleeding complication.
• Observe the pressure dressing is tight, clean
and no signs of bleeding to prevent infection.
• Observe the client until their condition stable
and recover.
• Monitor vital signs after the procedure
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47. • Tidy the equipment and make sure CSSD
instruments are complete before sending to
autoclave.
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49. THANKS
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