• Unexplained anemia, leukopenia, or thrombocytopenia (aspiration
• Acute or chronic leukemia (aspiration only).
• Myeloproliferative disease.
• Non-Hodgkin or Hodgkin lymphoma.
• Childhood solid tumors (including sarcoma, Wilms tumor, neuroblastoma,
germ cell tumor).
• Bone marrow failure (including acquired aplastic anemia, Fanconi
anemia, Diamond-Blackfan syndrome).
• Fever of unknown origin.
• Storage disease.
• Monitoring during chemotherapy or following stem cell transplantation
• Congenital factor deficiency or acquired coagulation defect.
• Anticoagulation with warfarin or heparin.
• Severe thrombocytopenia.
• Infection or prior radiation at sample site.
• 10% povidone-iodine.
• Alcohol preparation pads or swabs.
• Sterile gloves, gown, and drape.
• Spinal and subcutaneous needles, 20 to 26 gauge.
• 1% lidocaine hydrochloride, injection.
• 8.4% sodium bicarbonate, injection, USP.
• Sodium heparin, injection, 1000 USP units/mL,
• Bone marrow aspiration needles (15 and 18 gauge, adjustable lengths).
• Bone marrow biopsy needles (11 and 13 gauge, 4 or 2 inches in
• Sterile syringes, 10 to 20 mL.
• Container with fixative for trephine biopsy specimen.
• Vacutainers; one for sodium heparin and one for ethylenediaminetetraacetic
• Gauze sponges.
• Risk of bleeding is low if adequate pressure
is provided over site to achieve primary hemostasis.
• Platelet transfusion is indicated when technical difficulties
are anticipated in patients, especially those who are obese, with
• Defects in coagulation should be corrected before the procedure.
• Risk of infection and osteomyelitis is extremely low when procedure
is performed in sterile fashion.
• Pain and discomfort are alleviated with adequate sedation and
• Bone marrow examination provides critical
information in the diagnosis of various hematologic and oncologic
conditions in children.
• Bone marrow aspiration also permits immunophenotyping, cytogenetic
analysis, and other molecular studies.
• Adolescents may require only local anesthesia
for the procedure.
• Conscious sedation or general anesthesia is generally necessary
in young children, particularly if repeated procedures are required.
• Adding local anesthesia in young patients also decreases postprocedural
discomfort at the site.
• Lidocaine used for local anesthesia should be buffered with sodium
bicarbonate (sodium bicarbonate mixed with lidocaine in a 1:4 ratio)
to reduce burning during injection.
• Obtaining spicules (bone marrow particles rich in hematopoietic
elements) on the first pull of the aspiration may be easier using
a larger syringe (30 or 60 mL).
• Aspirating more than 0.25 mL of marrow initially dilutes the
sample with sinusoidal blood and interferes with morphologic studies.
• If an aspirate is “dry” and an adequate specimen
cannot be obtained, a touch imprint of the biopsy core may be helpful
for cytologic examination.
• A dry tap usually indicates myelofibrosis or a marrow ...
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