Pocket Oncology (Pocket Notebook Series), 1st Ed.

PERFORMING BM BIOPSY/ASPIRATE

Matthew A. Lunning

Selected Common Indications

• Cytopenias (Idiopathic) or Pancytopenia (MDS, AML), Lymphoproliferative disorders (NHL, MM, ALL), Storage (Fe, amyloidosis, Gaucher’s), FUO, Peripheral blood abnormalities (MPD, MDS), Myelophthisis (Solid tumor involvement)

Equipment

• Sterile skin preparation & sterile field equipment

• Lidocaine buffered w/NaHCO3, 25-gauge needle & 5-mL syringe

• BM aspiration needle & BM bx needle (ie, Jamshidi needle)

• Two 30-mL syringes, sterile heparin sulfate, sterile gauze & bandage

Location

• Iliac crest (posterior preferred, reached in either prone or decubitus position w/knees flexed → anterior can be used, rarely); sternum may be used only under exceptional circumstances (aspirate only)

Steps

• Obtain informed consent; perform time-out (institution dependent)

• Position pt (prone or lateral decubitus) → Identify landmarks (posterior iliac spine) → Cleanse area (chlorhexidine or Iodine solution)

• Local anesthetic (Lidocaine 1% or 2%)

• Slowly instill to raise a wheel & then administer in a star-like distribution, to check effects of anesthesia may tap periosteum gently

• Aspiration of marrow (Illinois needle)

• Prefilled tubes w/anticoagulant (EDTA)

• Inspect needle, ensure proper function, remove plastic guards if present

• Hold needle horizontally → insert of posterior iliac crest until bone is encountered → rotate needle gently using clockwise/counterclockwise motions while applying pressure → ↓ resistance will be felt when through cortex & marrow is entered

• Remove stylet & attach 30-mL syringe (no heparin) → aspirate marrow (can be painful) → use sample to create slides (adequate if w/presence of bony spicules), may be performed by assistant

• Attach syringes (w/heparin) → for diagnostic tests

• Remove aspiration needle & apply pressure to prevent bleeding

• Core bx (Jamshidi needle)

• Ensure proper function

• Insert larger bx needle into same entry site as aspiration needle (may need to widen w/small incision) → adv w/stylet in place → remove stylet once anchored in bone

• Continue to adv needle by 1–2 cm (a core length > 1.5 cm preferred; stylet may be reinserted to determine length of specimen) w/a rotating motion to obtain core → rotate 360 degrees clockwise & counterclockwise then rock back & forth to make sure core is detached from surrounding marrow → withdraw needle w/similar rotating motion → remove specimen from needle by inserting sterile probe to push specimen out onto slide/gauze