Bone Marrow Biopsy and Aspiration: Clinical Protocol

Pre-Procedure Requirements

Patient Preparation

• Review complete blood count and coagulation profile
• Obtain informed consent
• Document current medications, especially anticoagulants
• Verify no contraindications exist
• Mark anatomical site (typically posterior iliac crest)

Equipment Needed

• Sterile drapes and PPE
• Antiseptic solution (chlorhexidine or betadine)
• Local anesthetic (1-2% lidocaine)
• Bone marrow biopsy needle set
• Specimen collection containers
• Slides for smears
• Emergency kit

Procedure Steps

1. Patient Positioning and Site Preparation

1. Position patient in lateral decubitus or prone position
2. Identify posterior iliac crest
3. Mark site 2-3cm posterior to posterior iliac spine
4. Prepare area with antiseptic solution
5. Apply sterile drapes

2. Local Anesthesia

1. Infiltrate skin with lidocaine
2. Advance needle to periosteum
3. Infiltrate periosteum thoroughly
4. Wait 2-3 minutes for full effect

3. Aspiration Procedure

1. Insert aspiration needle through anesthetized tract
2. Advance through cortex with clockwise-counterclockwise motion
3. Remove stylet when positioned
4. Attach 10-20mL syringe
5. Aspirate 0.5-1.0mL of marrow
6. Prepare slides immediately

4. Core Biopsy

1. Insert biopsy needle through same site
2. Advance 2-3cm into marrow cavity
3. Rotate needle 360° to capture core
4. Remove specimen carefully

Post-Procedure Care

Immediate Care

• Apply pressure dressing
• Monitor vital signs
• Observe for complications
• Document procedure

Patient Instructions

• Keep dressing dry for 24 hours
• Avoid strenuous activity for 24 hours
• Report excessive bleeding or fever
• Schedule follow-up as needed

Quality Assurance

Specimen Handling

• Label all specimens immediately
• Complete requisition forms
• Transport to laboratory within 30 minutes
• Document specimen adequacy

Documentation Requirements

• Procedure notes
• Complications if any
• Patient tolerance
• Follow-up plans