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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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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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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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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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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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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