Anatomy

Site selection for bone marrow aspiration depends on patient age and the clinician’s experience. The posterior iliac crest is the most common site for bone marrow aspiration; bone marrow biopsy is nearly exclusively performed at this site (Fig. 205-1A). The sternum can be used for aspiration in adults, but it is never appropriate for biopsy (Fig. 205-1B; cardiac tamponade is a possibility if the posterior sternum were to be inadvertently penetrated). Figure 205-2 shows the Illinois needle, designed specifically for sternal bone marrow aspiration. The anterior iliac crest is an option for both bone marrow aspiration and biopsy, although the hard, thick cortical layer of bone makes this approach technically challenging. The anterior iliac crest is most often used when biopsy of the posterior iliac crest is contraindicated (e.g., significant obesity, physical disability, or presence of a cast). The anterior tibia is an option for marrow aspiration in infants younger than 18 months of age.

Figure 205-1 A, Posterior iliac sampling site. B, Sternal sampling site.

Figure 205-2 Illinois needle for sternal bone marrow aspiration.

(Courtesy of Cardinal Health, Dublin, Ohio.)

Aspiration and biopsy techniques for the posterior iliac crest are described in this chapter. Aspiration and biopsy at this site are both easily accessible and safe when performed properly.

Indications

Contraindications

Equipment

Necessary equipment is available in sterile, disposable, prepackaged kits (Fig. 205-3).

• 22-gauge (-inch) and 25-gauge (-inch) needles

Figure 205-3 Prepackaged sterile Jamshidi bone marrow biopsy kit.

(Courtesy of Cardinal Health, Dublin, Ohio.)

Figure 205-4 Bone marrow aspiration needle.

(Courtesy of Cardinal Health, Dublin, Ohio.)

Figure 205-5 Jamshidi bone marrow biopsy needle.

(Courtesy of Cardinal Health, Dublin, Ohio.)

Precautions

Review the patient history and indications for bone marrow sampling. Question the patient about recent use of medications that might depress bone marrow function or stimulate blood formation (e.g., cytokines). Results of a complete blood count and peripheral blood smear should be reviewed before considering bone marrow aspiration and biopsy.

Preprocedure Patient Education

A cooperative patient is essential. Discuss indications for the procedure, as well as risks and benefits. Obtain a signed informed consent (see the sample patient consent form online at www.expertconsult.com). Inquire about any coagulation abnormalities or allergies (i.e., povidone–iodine or lidocaine). Explain that numbing the skin and periosteum, penetrating the iliac crest, and aspirating marrow is sometimes uncomfortable. Have the patient empty his or her bladder before the procedure. In overly apprehensive patients, premedication with a mild anxiolytic or analgesic is appropriate. Oral lorazepam (1 to 2 mg) and hydromorphone (1 to 2 mg) given 60 to 90 minutes before the biopsy lessen pain and induce varying degrees of amnesia.