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  • • Pancytopenia.

    • Unexplained anemia, leukopenia, or thrombocytopenia (aspiration only).

    • Acute or chronic leukemia (aspiration only).

    • Myelodysplasia.

    • 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 (aspiration only).

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Relative

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  • • Congenital factor deficiency or acquired coagulation defect.

    • Anticoagulation with warfarin or heparin.

    • Severe thrombocytopenia.

    • Infection or prior radiation at sample site.

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Site Preparation

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  • • 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.

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Marrow Aspiration and Biopsy

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  • • Sodium heparin, injection, 1000 USP units/mL, preservative free.

    • Bone marrow aspiration needles (15 and 18 gauge, adjustable lengths).

    • Bone marrow biopsy needles (11 and 13 gauge, 4 or 2 inches in length).

    • Sterile syringes, 10 to 20 mL.

    • Container with fixative for trephine biopsy specimen.

    • Vacutainers; one for sodium heparin and one for ethylenediaminetetraacetic acid (EDTA).

    • Gauze sponges.

    • Bandages.

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  • • 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 severe thrombocytopenia.

      • 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 analgesics.

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• 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.

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  • • 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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