BEE ENN COLLEGE OF NURSING

PROCEDURE
ON

BONE MARROW ASPIRATION

SUBMITTED TO SUBMITTED BY

MS Rimple Pathania Ms. Tabeena Javeed

Nursing Tutor M.Sc. (N) 1st year

Child Health Nursing Child Health Nursing

BECON BECON

SUBMITTED ON
BONE MARROW ASPIRATION (BMA)

INTRODUCTION:-

Bone marrow aspiration is a medical procedure used to collect a sample of the soft, spongy
tissue found inside bones called bone marrow. This procedure is often performed to diagnose
various blood disorders, such as leukaemia, lymphoma, and multiple myeloma, as well as to
evaluate the production of blood cells or the presence of infections within the bone marrow.

During a bone marrow aspiration, a healthcare provider inserts a needle into the bone, typically
the hip bone (pelvis), and withdraws a small amount of bone marrow fluid and cells. This
sample is then examined under a microscope to assess the composition and health of the bone
marrow.

Bone marrow aspiration is usually performed in a hospital or clinic setting and may be done
under local anaesthesia to minimize discomfort. It is a relatively quick procedure, typically
lasting around 15 to 30 minutes.

The information gathered from a bone marrow aspiration can provide valuable insights into a
patient's overall health and help guide treatment decisions. It is an important tool in the
diagnosis and management of various hematologic (blood-related) conditions.

DEFINITION:-

Bone marrow aspiration is a medical procedure where a small amount of liquid bone marrow
is withdrawn through a needle for examination. The bone marrow, found inside certain bones
like the hip or breastbone, produces blood cells, including red blood cells, white blood cells,
and platelets. Aspiration is typically performed to diagnose blood disorders, such as leukaemia,
lymphoma, or certain infections, or to assess the bone marrow's function and cell composition.
The procedure is often done under local anaesthesia and may cause temporary discomfort.

PURPOSES:-

Bone marrow aspiration in paediatrics serves several purposes, primarily for diagnostic and
therapeutic reasons:

1)Diagnostic Purposes:

Evaluation of Blood Disorders: Bone marrow aspiration helps in the diagnosis and
classification of various blood disorders such as leukaemia, anaemia, and thrombocytopenia.
Assessment of Bone Marrow Function: It aids in assessing the bone marrow's ability to
produce blood cells.
Detection of Metastatic Diseases: In cases of suspected metastatic diseases, bone marrow
aspiration can help in detecting the spread of cancer cells to the bone marrow.
Evaluation of Infections: Bone marrow aspiration may be performed to diagnose certain
infections like tuberculosis or fungal infections that affect the bone marrow.

2)Therapeutic Purposes:

Hematopoietic Stem Cell Transplantation (HSCT): Bone marrow aspiration is often done
to collect hematopoietic stem cells for transplantation in conditions like leukaemia, aplastic
anaemia, and certain genetic disorders.
Treatment of Hematologic Disorders: In some cases, bone marrow aspiration may be part of
the treatment process, such as in the management of leukaemia to assess response to therapy
or to guide further treatment decisions.

3)Monitoring Disease Progression and Response to Treatment:

Serial bone marrow aspirations may be performed to monitor disease progression and response
to treatment in conditions like leukaemia, lymphoma, or myelodysplastic syndromes.

4)Research Purposes:

Bone marrow aspiration in paediatrics also contributes to medical research aimed at

understanding the pathophysiology of various hematologic disorders and developing better
treatment strategies.

Overall, bone marrow aspiration plays a crucial role in the diagnosis, treatment, and
management of various hematologic disorders in paediatric patients.

INDICATIONS:-

Bone marrow aspiration in paediatrics is typically indicated for various diagnostic purposes,
including:

1)Evaluation of Blood Disorders: When a child presents with unexplained anaemia,

thrombocytopenia (low platelet count), leukopenia (low white blood cell count), or other blood
abnormalities, bone marrow aspiration may be performed to evaluate the underlying cause.

2)Assessment of Hematologic Malignancies: In cases suspected of leukaemia, lymphoma, or

other hematologic malignancies, bone marrow aspiration is crucial for obtaining a definitive
diagnosis and determining disease extent.

3)Investigation of Bone Marrow Failure Syndromes: Certain congenital or acquired

conditions, such as aplastic anaemia or Fanconi anaemia, may necessitate bone marrow
aspiration to assess the bone marrow's ability to produce blood cells adequately.

4)Diagnosis of Infections: Bone marrow aspiration can be useful in diagnosing certain

infections that affect the bone marrow directly, such as tuberculosis or fungal infections.
5)Evaluation of Storage Disorders: Inherited metabolic disorders affecting the bone marrow,
such as Gaucher disease or Niemann-Pick disease, may require bone marrow aspiration for
diagnosis and monitoring.

6)Assessment of Hemophagocytic Lymph histiocytosis (HLH): HLH is a life-threatening

syndrome characterized by immune dysregulation and excessive inflammation. Bone marrow
aspiration may aid in diagnosing HLH by revealing evidence of hem phagocytosis.

7)Monitoring Disease Response: Following treatment for certain conditions like leukaemia,
bone marrow aspiration may be performed to assess treatment response and disease
progression.

8)Investigation of Pancytopenia: When a child presents with low levels of all three blood cell
types (red blood cells, white blood cells, and platelets), bone marrow aspiration can help
identify the underlying cause, such as aplastic anaemia or myelodysplastic syndrome.

CONTRAINDICATIONS:-

Bone marrow aspiration is a procedure commonly performed in paediatrics for diagnostic and
therapeutic purposes. However, there are certain contraindications and precautions that
healthcare providers need to consider before performing this procedure on paediatric patients:

1)Coagulopathy: Patients with bleeding disorders or abnormal coagulation parameters may be

at increased risk of bleeding complications during bone marrow aspiration. It's important to
assess the patient's coagulation status before the procedure and correct any abnormalities if
possible.

2)Local Infection: If there is evidence of local infection at the site where the bone marrow
aspiration will be performed, it may increase the risk of introducing bacteria into the
bloodstream or causing local complications. In such cases, the procedure should be postponed
until the infection is adequately treated.

3)Osteoporosis or Bone Weakness: In patients with weakened bones due to conditions like
osteoporosis or bone metastases, there may be an increased risk of fracture during the bone
marrow aspiration procedure. Careful consideration should be given to the choice of site and
technique to minimize this risk.

4)Severe Anaemia or Thrombocytopenia: In patients with severe anaemia or

thrombocytopenia, bone marrow aspiration may exacerbate these conditions and lead to further
complications such as haemorrhage. The benefits of the procedure should be carefully weighed
against the risks in these cases.

5)Patient Cooperation: Bone marrow aspiration requires patient cooperation and the ability
to lie still during the procedure. In paediatric patients who are unable to cooperate or tolerate
the procedure, sedation or anaesthesia may be required, which carries its own risks and
considerations.
6)Localized Tumour Involvement: In cases where there is a localized tumour or mass near
the site of bone marrow aspiration, there may be an increased risk of tumour seeding or
dissemination during the procedure. Alternative diagnostic methods may need to be considered
in these cases.

7)Patient's General Health Condition: The overall health condition of the paediatric patient
should be evaluated before performing bone marrow aspiration. Patients with significant
comorbidities or compromised immune systems may be at increased risk of complications and
may require additional precautions or modifications to the procedure.

SIZE OF NEEDLE:-

In paediatric bone marrow aspiration, the needle size typically varies depending on the age and
size of the child, as well as the preference of the healthcare provider. Commonly, a smaller
gauge needle is used to minimize discomfort and reduce the risk of complications. In infants
and young children, a needle size ranging from 20 to 25 gauge is often utilized. As the child
grows older and larger, a slightly larger gauge needle may be employed, typically ranging from
18 to 22 gauge. However, specific protocols and preferences may vary among healthcare
institutions and practitioners. It's always best to consult with a paediatric
haematologist/oncologist or another qualified healthcare provider for the most accurate
information regarding needle size for bone marrow aspiration in paediatric patients.

STEPS OF PROCEDURE:-

1)Preparation:

*Explain the procedure to the child and their parents or guardians in age-appropriate language,
ensuring they understand what to expect.
*Obtain informed consent from the parent or legal guardian.
*Gather all necessary equipment, including sterile gloves, masks, sterile drapes, antiseptic
solution, local anaesthetic, syringes, needles, and bone marrow aspiration needle.

2)Positioning:

*Position the child either lying on their side or stomach, depending on the preference of the
physician and the child's size and cooperation.
*Ensure the child is comfortable and adequately supported.

3)Anaesthesia:

*Administer local anaesthesia to the skin and periosteum (outer layer of bone) at the site where
the needle will be inserted. This helps to minimize discomfort during the procedure.
4)Sterilization:

*Cleanse the skin over the intended aspiration site (typically the posterior superior iliac spine)
with an antiseptic solution to reduce the risk of infection.

5)Needle insertion:

*Once the area is numb and sterile, the physician will carefully insert the bone marrow
aspiration needle through the skin and into the bone marrow cavity.
*The needle is typically rotated and gently advanced until it reaches the marrow space within
the bone.

6)Aspiration:

*Attach a syringe to the needle and gently aspirate (draw back) on the plunger to obtain a
sample of bone marrow fluid.
*The physician may need to reposition the needle slightly to access different areas of the
marrow cavity and obtain an adequate sample.

7)Sample collection:

*Once an adequate sample has been obtained, detach the syringe from the needle and carefully
transfer the bone marrow fluid into appropriate collection tubes for analysis.
*Label the tubes with the patient's identifying information.

8)Post-procedure care:

*Apply pressure to the aspiration site to minimize bleeding and the risk of hematoma
formation.
*Bandage the site as needed.
*Monitor the child for any signs of complications, such as excessive bleeding or infection.

9)Disposal:

Properly dispose of all used needles, syringes, and other medical waste according to established
protocols.

10)Documentation:

Document the procedure, including the site of aspiration, volume of bone marrow aspirated,
any complications encountered, and the patient's tolerance of the procedure.

11)Follow-up:
*Provide post-procedure instructions to the child and their caregivers, including any limitations
on activity and signs of complications to watch for.
*Schedule any necessary follow-up appointments to discuss the results of the bone marrow
aspiration and plan further management if needed.
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