Imaging Pearls ❯ Musculoskeletal ❯ Post Operative Studies
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- Bone marrow sampling is an invasive procedure that can be obtained by aspiration and biopsy(also called trephine biopsy) and as such, requires good technical skills to avoid complications and increase diagnostic yield. Aspirate and biopsy samples are complementary and when obtained together, are an invaluable tool toward obtaining an accurate and comprehensive profile for cellular, cytogenetic, immunophenotypic and cytological assessments. Bone marrow aspiration and trephine biopsy are generally regarded as relatively low risk procedures, however, factors that should be taken into consideration include disseminated intravascular coagulopathy, factor deficiencies, skin infections, and severe thrombocytopenia. In adults, the posterior iliac crest is often the preferred site but other accessed sites include the sternum (aspiration only) and anterior superior iliac crest in obese patients. For procedures performed at the posterior iliac spine, possible complications include pain, bleeding and infection.
- Results: Of the 233 patients on which bone marrow aspirates and/or biopsies were attempted, 217 (93%) were performed successfully. 16 (7%) were unsuccessful with those patients subsequently referred to interventional radiology for placement under CT guidance. Of the procedures which were successful, 181 (83.4%) were successful with the first attempt, while 36 (16.6%) required more than one attempt. 1 (0.4%) patient experienced a procedural complication secondary to a hematoma.
Conclusions: We propose that bone marrow sampling performed by a hospitalist procedure services is a safe and efficacious option and alternative for busy inpatient hematology/oncology services as it can provide faster access to care for patients who need the procedure. It also helps liberate hematology/oncology providers from performing these procedures to allow them the opportunity to focus on patient care and rounds.
Safety Profile of Bone Marrow Aspiration and Biopsies Performed By the Hospitalist Procedure Service at an Academic Center: An Observational Study
Jennifer U Obasi, MD, Adrian P Umpierrez De Reguero, MD
Blood (2019) 134 (Supplement_1): 5848 - Bone Marrow Biopsy: Complications
- Hemorrhage — most common side effect of a bone marrow biopsy
- Excessive bleeding — more common in people with low platelet numbers
- Allergic reaction to anesthesia
- Infection — more common in people with weakened immune systems
- Persistent pain at biopsy site
- Post Operative Complications
- Nonunion
- Osteolysis (loosening and particle disease)
- Infection
- New fracture
- Malplacement
- Hardware fracture
- Heterotopic Ossification - "For the evaluation of the post-operative skeleton, 3D CT imaging carries an advantage over traditional axial and MPR views by markedly diminishing artifacts associated with the presence of hardware."
CT of the Postoperative Patient: Value of 3D Imaging in Defining Skeletal Complications of Orthopedic Hardware
Fayad LM, Patra A, Fishman EK
AJR (in press) - "With the optimization of CT parameters and the evolution of 3D CT imaging, metal related artifacts can be diminished and allow for diagnostic examinations in most clinical scenarios."
CT of the Postoperative Patient: Value of 3D Imaging in Defining Skeletal Complications of Orthopedic Hardware
Fayad LM, Patra A, Fishman EK
AJR (in press)