Bone Marrow Biopsy and Aspiration PDF

‫‪Bone Marrow biopsy and aspiration‬‬ ‫الدراسة الصباحية‬ ‫إعداد الطلبة‬ ‫زينب علي ريسان‬ ‫زينب هادي بادي‬ ‫فاطمه عبد الحسن‬ ‫بإشراف‬ ‫الدكتور حسن‬  Introduction: Bone marrow : is the spongy, fatty tissue found inside the b...

‫‪Bone Marrow biopsy and aspiration‬‬ ‫الدراسة الصباحية‬ ‫إعداد الطلبة‬ ‫زينب علي ريسان‬ ‫زينب هادي بادي‬ ‫فاطمه عبد الحسن‬ ‫بإشراف‬ ‫الدكتور حسن‬  Introduction: Bone marrow : is the spongy, fatty tissue found inside the body's larger bones (thigh, hips, rips ). it has liquid and solid parts. Bone marrow make blood cells :RBCs, WBCs, and platelets. Difference between biopsy and aspiration Bone marrow biopsy : takes a sample of the solid, spongy part of bone marrow Bone marrow aspiration : takes a sample of the liquid portion of bone marrow.  Purpose of Bone Marrow Biopsy and Aspiration: The purpose is to diagnose a variety of blood diseases; Whether cancerous or non-cancerous. A bone marrow biopsy can diagnose blood cancers, such as leukemia, lymphoma, and multiple myeloma.  Equipment for Bone Marrow Biopsy and Aspiration A computed tomography (CT) scanner may be utilized if indicated. This is often the case when an interventional radiologist performs the procedure. A bone marrow kit should be utilized containing: _Sterile drapes _Needles _Syringes _An aspiration needle  Cont: _A biopsy needle. If performed on the posterior iliac crest, a Jamshidi needle is often preferred for biopsy. _1% to 2% lidocaine with or without epinephrine _Specimen slides _Specimen containers will be required as well. The number of required pathology slides and specimen containers will vary depending on the type of pathology under investigation and whether or not a biopsy will be performed in addition to the aspiration.  Site of procedure Bone marrow aspiration and trephine biopsy are usually performed : 1- on the back of the hipbone, or posterior iliac crest. 2- An aspirate can also be obtained from the sternum (breastbone). For the sternal aspirate, the patient lies on their back, with a pillow under the shoulder to raise the chest. A trephine biopsy should never be performed on the sternum, due to the risk of injury to blood vessels, lungs or the heart. 3- Bone marrow aspiration may also be performed on the tibial (shinbone) site in children up to 2 years of age while spinous process aspiration is frequently done in a lumbar puncture position and on the L3-L 4  Anesthesia is used to reduce surface pain at the spot where the needle is inserted. Pain may result from the procedure's insult to the marrow, which cannot be anesthetized, as well as short periods of pain from the anesthetic process itself. The experience is not uniform; different patients report different levels of pain, and some do not report any pain at certain expected points.  Common clinical indications for bone marrow aspirations : the cause of anemia (too few red blood cells, which carry oxygen through the body) the cause of thrombocytopenia (too few platelets, which help the blood to clot) the cause of an abnormal number of white blood cells, which fight infections cancers of the blood, such as leukemia  whether cancers that started elsewhere have spread to the bone marrow (the assessment of how much a cancer has spread is called staging, and is important in determining treatment and prognosis). viral, bacterial, or fungal infections in the bone marrow that might be causing lasting fever or other symptoms. certain genetic diseases (such as lipid storage diseases). Bone marrow aspiration and/or biopsy is contraindicated : patients with severe hemophilia severe disseminated intravascular coagulation, or other related severe bleeding disorders.  procedure A bone marrow aspiration and biopsy usually takes about 30 minutes. Your child may be asked to change into a cloth gown, and then will be positioned on an exam table on the stomach or side, and the skin will be cleaned with a special antiseptic soap. This sterilizes the skin If your child is sedated the vital signs (heart rate, blood pressure, temperature, and blood oxygen level) will be monitored during the procedure. Your child may have a blood pressure cuff around the upper arm and a small fingertip clip to monitor the blood oxygen level. The procedure of bone marrow aspiration and biopsy. Bone marrow aspiration and biopsy are painful procedures. The patient should receive a judicious amount of local anesthetic. For pediatric patients, the administration of sedation by an anesthesiologist other-. If the site of the procedure is the pelvic bone, the patient lies on his stomach or on his side above the bed.  Cont: Bone marrow aspiration usually comes first. The doctor inserts a hollow needle into the numbed area and pushes gently into the bone. Then, removes the center portion of the hollow needle and attaches a syringe to the needle. The syringe withdraws the liquid portion of the bone marrow. You may feel a deep, dull, aching pain for a few seconds, similar to a toothache.  Cont: For the bone marrow biopsy, the medical specialist inserts a larger needle into the same area. They will guide the needle into the bone and rotate it to remove a sample of tissue. You may feel pain and pressure as the needle moves into the bone. The medical specialist will then remove the entire needle. Next, they will place a bandage over the site to prevent bleeding. Nursing care before procedure Identify the child using two patient identifiers (e. g, patient name, and medical record or birth date; neither can be a room number). Compare the same two identifiers with the specimen container and order. Explain the procedure to parents and child according to the developmental level of the child; re assure the child that the procedure is not punishment.  Cont:.Determine the ability of the child to stay during the procedure and explain the importance of doing so..Perform hand hygiene, maintain aseptic technique, and follow standard precautions..Take vital signs and administer sedatives as ordered.Help him to the appropriate position: lateral decubitus or prone if the insertion site will be the posterior iliac crest, supine if the sternum or anterior iliac crest will be used  Nursing Care During procedure 1- The child is usually given anesthesia, or sedation and analgesia. Follow monitoring guidelines during and after the procedure. 2- The site is prepped with a cleansing agent according to agency protocol. 3- Positioning is determined by the site used (e.g., side-lying for the iliac crest). 4- Evaluation of vital signs. 5- Mild analgesics are provided for pain at the harvest site.  Nursing Care after procedure Apply pressur to the area where the needle was inserted to stop the bleeding. Giving a pain reliever such as acetaminophen Prevent the patient from doing any leg activity or exercise for a day or two Put a clean,dry bandaage on the needle site for 24 hours Maintain the child on bed rest for at least 1 hour. After that,a specialist in analyzing biopsies in the laboratory evaluates the samples wether the bone marrow is producing enough healthy blood cells or not,confirms the diagnosis of condition ,determines the extent of disease progression  Complications: Excessive bleeding, particularly in people with low numbers of a certain type of blood cell (platelets) infection, generally of the skin at the site of the exam, especially in people with weakened immune systems long-lasting discomfort at the bone marrow exam site  Cont: you may feel some tenderness or discomfort after the numbing medicine wears off. The biopsy site may be stiff and sore for several days after the biopsy and you may have a bruise on the site.... The risks are rare and most often associated with conditions that cause a weakened immune system or low platelet count a weakened immune system can make you more prone to infection. A low platelet count increases your risk of excessive bleeding.  References: ▪ Riley, R. S., Hogan, T. F., Pavot, D. R., Forysthe, R., Massey, D., Smith, E.,... & Ben‐ezra, j. M. (2004). A pathologist's perspective on bone marrow aspiration and biopsy: I. Performing a bone marrow examination. Journal of clinical laboratory analysis, 18(2), 70-90. Iso 690 ▪ Malempati, S., Joshi, S., Lai, S., Braner, D. A., & Tegtmeyer, K. (2009). Bone marrow aspiration and biopsy. N engl J med, 361(15), 28. Iso 690 ▪ Draganski E, et al. Bone marrow aspiration and biopsy performed by rns: A review of clinical practice. American journal of nursing. 2019;119:48.