bone marrow aspiration.pptx

Bone marrow aspiration

1. Bone Marrow Aspiration

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. 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

4. 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 .

5. 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.

6. 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.

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8. 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

9. 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

10. Bone marrow from the superior part of the posterior iliac spine (back of the hipbone) 11

11. 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) M arrow aspiration may be difficult or impossible, the so-called dry tap In such cases, a needle or trephine biopsy is essential 13

12. 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

13. 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

14. 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

15. 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

16. Nursing Interventions Nursing responsibilities include  preparing and educating the patient, assessing him for complications, supporting him during the procedure, and assisting the practitioner . After aspiration, apply direct pressure over the puncture site for 5-10 minutes until bleeding stops Help the patient to a comfortable position Clean the puncture site and apply a sterile dressing. Monitor the patient’s vital signs and the puncture site for signs and symptoms of infection.

17. Complications Hemorrhage and infection Puncture of the mediastinum (sternum)

18. Thanks