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Questions and Answers
What factor influences the number of required pathology slides and specimen containers?
What factor influences the number of required pathology slides and specimen containers?
Which scenario requires the potential for additional pathology slides?
Which scenario requires the potential for additional pathology slides?
How does the type of pathology influence specimen handling?
How does the type of pathology influence specimen handling?
What aspect is not mentioned as influencing the number of pathology slides needed?
What aspect is not mentioned as influencing the number of pathology slides needed?
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What is the impact of performing a biopsy on pathology specimens?
What is the impact of performing a biopsy on pathology specimens?
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Which of the following items is NOT typically included in a bone marrow kit for an interventional procedure?
Which of the following items is NOT typically included in a bone marrow kit for an interventional procedure?
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What is the purpose of using sterile drapes in a bone marrow procedure?
What is the purpose of using sterile drapes in a bone marrow procedure?
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Which of the following is specifically noted as part of a bone marrow kit in interventional radiology?
Which of the following is specifically noted as part of a bone marrow kit in interventional radiology?
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When performing a bone marrow procedure, what role do syringes play?
When performing a bone marrow procedure, what role do syringes play?
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In the context of a bone marrow kit, which two types of needles are specifically listed?
In the context of a bone marrow kit, which two types of needles are specifically listed?
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In which condition is bone marrow aspiration and/or biopsy contraindicated?
In which condition is bone marrow aspiration and/or biopsy contraindicated?
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Which of the following bleeding disorders would prevent a bone marrow biopsy?
Which of the following bleeding disorders would prevent a bone marrow biopsy?
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What is a common reason for contraindication of a bone marrow aspiration?
What is a common reason for contraindication of a bone marrow aspiration?
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Which patient condition does NOT contraindicate bone marrow aspiration?
Which patient condition does NOT contraindicate bone marrow aspiration?
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Bone marrow biopsy is particularly contraindicated in patients with what severity of bleeding disorders?
Bone marrow biopsy is particularly contraindicated in patients with what severity of bleeding disorders?
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Study Notes
Bone Marrow Biopsy and Aspiration
- Bone marrow is a spongy, fatty tissue found inside the body's larger bones (thighs, hips, ribs)
- It contains liquid and solid parts
- Bone marrow produces blood cells: red blood cells (RBCs), white blood cells (WBCs), and platelets
Differences Between Biopsy and Aspiration
- Bone marrow biopsy: A sample of the solid, spongy part of the bone marrow is taken.
- Bone marrow aspiration: A sample of the liquid portion of the bone marrow is taken.
Purpose of the Procedure
- Diagnosing various blood disorders, whether cancerous or non-cancerous
- Identifying blood cancers such as leukemia, lymphoma, and multiple myeloma
Equipment
- CT (computed tomography) scanner (if needed, often for interventional radiologist procedures)
- Sterile drapes
- Needles
- Syringes
- Aspiration needle
Procedure Details
- Biopsy needle: A biopsy needle, sometimes a Jamshidi needle (for posterior iliac crest biopsies), is used.
- Anesthetic: 1% to 2% lidocaine with or without epinephrine is typically used.
- Specimen preparation: Specimen slides and containers are required, the number varying based on the type of test, and whether it's a biopsy or aspiration or both.
Procedure Site
- Posterior iliac crest: Common site for both aspiration and biopsy
- Sternum (breastbone): Also a site for aspiration. Biopsy is not recommended here due to the risk to blood vessels, lungs, and the heart.
- Tibial site (shinbone): Acceptable for children up to age 2 years.
- Lumbar puncture position (L3-L4): Used for aspiration in some cases.
Procedure Pain and Anesthesia
- The procedure itself can be painful
- Local anesthetic is necessary
- Sedation is frequently used for pediatric patients
- Pain can also result from the anesthetic itself and the needle insertion into the marrow
- Patient experiences vary
Procedure Sites (Diagram)
- Shows common sites: posterior superior iliac crest, sternum, and anterior superior iliac crest
Common Indications
- Diagnosing anemia (low red blood cell count)
- Diagnosing thrombocytopenia (low platelet count)
- Diagnosing abnormalities in white blood cell counts
- Examining spread of cancers to the bone marrow, and staging
- Investigating viral, bacterial, or fungal infections in the bone marrow
- Assessing certain genetic diseases (e.g., lipid storage diseases)
Contraindications
- Patients with severe hemophilia
- Patients with severe disseminated intravascular coagulation (DIC)
- Other related severe bleeding disorders
Procedure Time and Preparation
- Procedure usually takes about 30 minutes
- The skin is cleaned with antiseptic soap
- Vital signs (heart rate, blood pressure, temperature, blood oxygen) are monitored
- Child is positioned appropriately (lateral decubitus or prone for posterior iliac crest, supine for sternum)
- Sedation may be used
Nursing Care
-
Before:
- Patient identification confirmation
- Explaining the procedure to the patient and family
- Determining child's ability to remain still during the procedure
- Hand hygiene and aseptic technique follow-up
- Administering sedatives as ordered
-
During:
- Anesthesia and analgesia administration for patient
- The site preparation (cleansing, prep)
- Monitoring vital signs throughout procedure
- Appropriate positioning
- Providing mild analgesics at the harvest site
-
After:
- Pressure to the needle site to stop bleeding
- Giving pain relievers, such as acetaminophen
- Rest period, avoiding leg activity for a day or two
- Clean, dry bandage on the needle site
- Maintaining bed rest for at least 1 hour
-
Evaluate bone marrow for health/disease
Complications
- Excessive bleeding (particularly in those with low platelets)
- Site infection (especially in people with weakened immune systems)
- Long-lasting discomfort at the bone marrow exam site
Post-Procedure Discomfort
- Tenderness or discomfort after the numbing medicine wears off
- The biopsy site may be stiff and sore for days
- Possible bruising at the site
Laboratory Analysis
- Laboratory specialists analyze biopsy/aspirate
- Determine if the bone marrow is producing enough healthy blood cells
- Confirm or deny the diagnosis of a condition
- Assess the extent of disease progression.
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Description
This quiz covers the essential aspects of bone marrow biopsies and aspirations, including their purposes, differences, and procedure details. It also highlights the equipment used and the significance of these procedures in diagnosing blood disorders. Test your knowledge on this crucial medical topic!
