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Bone marrow aspiration and biopsies are often performed both in the inpatient and outpatient settings for the diagnosis of a multitude of hematologic disorders. Both the palpation-guided and computed-tomography-guided approaches are common methods for performing this procedure and have high diagnostic accuracy as well as low complication rates. This activity outlines the proper procedural steps in performing a bone marrow aspiration and biopsy and highlights the role of the interprofessional team in managing patients who undergo this procedure. Objectives: Review the indications for a bone marrow aspiration and biopsy. Identify the equipment and personnel needed to perform a bone marrow aspiration and biopsy. Outline the potential complications of bone marrow aspirations and biopsies. Explain the importance of improving the coordination of care between members of the interprofessional care team in order to improve outcomes for patients who undergo a bone marrow aspiration and biopsy. Access free multiple choice questions on this topic.

Bone marrow aspiration and biopsies are often performed both in the inpatient and outpatient settings for the diagnosis of a multitude of hematologic disorders. Both the palpation-guided and computed tomography-guided (CT-guided) approaches are commonly utilized for performing this procedure. Both procedural methods have a high degree of accuracy and a low complication rate.[1] The proper procedural steps in performing a bone marrow aspiration and biopsy will be explained as well as the roles of the interprofessional care team in managing patients who undergo this procedure. The steps involved in performing a bone marrow aspiration and biopsy, as well as the required personnel and materials, should be thoroughly understood prior to performing the procedure in order to avoid inadequate sampling or adverse patient outcomes. Additionally, the healthcare professional’s better understanding of the indications, perioperative management, and complications of this procedure can improve both patient experience and better diagnostic accuracy.

Post-operative bleeding is common due to the high vascularity of the sampled tissue. Manual pressure or a pressure dressing can be applied to the site until bleeding subsides. Rarely, retroperitoneal or gluteal hemorrhage can occur, which is typically due to injury of the internal iliac artery or superior gluteal artery.[16][17] These cases occur less frequently when the biopsy needle is accurately pointed towards the ipsilateral anterior superior iliac crest and does not exit through the cortex.[18] Hemorrhage, cardiac tamponade, and death can occur if a needle is misplaced during sternal aspiration, and extreme caution should be exercised if this site is chosen for sampling. Infection is at risk of any invasive procedure and can be minimized with proper sterile technique and avoiding areas of superficial infection or osteomyelitis when choosing a sampling site. Tumor seeding is another risk that must be explained to the patient if a biopsy is being performed at the site of a suspected metastatic lesion.[19] If the patient is to receive prior imaging, it is important to note the location where the aspiration and biopsy have been performed as the post-procedure changes can result in a false positive reading on positron emission tomography (PET) scanning or a bone scan.[20][21] Damage to local tissues can occur, especially in the case of a non-cooperative or combative patient. Patient compliance should be addressed during procedure planning, and the use of conscious sedation should be considered if necessary.

A potential source of error specifically pertinent to this procedure is the lack of adequate assistance. Utilizing assistants who are aware of the steps of the procedure, how the slides are prepared, and how the biopsy sample is prepared is key to ensuring that the procedure goes smoothly. Ensuring that an assistant is available can aid the clinician in performing the procedure so that they may focus on their own tasks. This can also be beneficial to the patient as the procedure time may decrease, and the number of sampling sites may be reduced due to the higher sampling quality. As previously mentioned, communication with the pathology department is also essential for obtaining high-quality samples. Another clinically relevant point is to properly assess and communicate with the patient both prior to and during the procedure. There are multiple points in the procedure that can cause pain to the patient, including penetration of the periosteum and aspiration of marrow. Proper clinician communication with the patient and/or guardian is essential in order to reduce patient confusion and discomfort. It is the responsibility of the healthcare providers involved in performing this procedure to understand it in its entirety as well as the importance of coordination of care with the end goal of improving patient outcomes.