Bone Marrow Biopsy

Overview

Pre-Procedure Prep

Indications

• Hematologic disorders such as leukemia, lymphoma, multiple myeloma, anemia, etc.

Contraindications

• Few if any
• Procedure can be performed in setting of thrombocytopenia
• Cellulitis at skin entry site or underlying soft tissue infection should prompt evaluation for different site

Pre-Procedural Evaluation

• H&P
• Prior imaging cross sectional imaging of the pelvis

Procedure Steps

Site

Most common site for bone marrow biopsy is iliac wing.

CT Guidance Commonly Used

• Prone patient with posterior approach
• Advance needle along length of the iliac wing.
• For right iliac wing biopsy, operator stands on patient's left and skin entry site is midline with lateral trajectory
• Seat needle just beyond cortex. Occasionally, helpful to have mallet to assist with seating the needle beyond the cortex
• Remove inner stylet. Aspirate with large volume syringe (20 - 30 mL)
• Following aspiration, advance biopsy device without inner stylet into iliac wing 2-3 cm,
• Can be helpful to gently rock biopsy device to help capture specimen. Many devices have additional tools to assist with specimen capture

Following Successful Aspirate and Bone Biopsy

• Hemostasis with compression
• Apply sterile dressing
• Option to take final pictures confirming no immediate post operative complication

Post-Procedure

Complications

• Rare
• Bleeding is most common
• Injury to surround structures
• Patient's can be sore 2-3 days following procedure
• Inadequate sample

Recovery

• 15 minutes bedrest if local only
• Often times, moderate sedation will necessitate more recovery time than actual biopsy