Morbidity and mortality associated with performing bone marrow aspiration and biopsy

Background: Bone marrow aspiration and biopsy are diagnostic methods in the study of hematological diseases. Complications are rare. Knowing the morbidity and mortality related to the procedure is essential in order to implement preventive behaviors and improvement plans. Objective: To determine the incidence of complications in patients over 18 years who were undergone to bone marrow biopsy and aspiration in a university hospital between October 2013 and May of 2015. Furthermore, frequency, socio-demographic and clinical characteristics were established as well. Materials & methods: Observational, descriptive and retrospective study. The unit of analysis was biopsies and bone marrow aspirations. The information was obtained from the database of outpatient hematology ward, into the program Group of Education and Monitoring of Egress (GESE) of the Hematology Service of Hospital de San José (Bogotá, Colombia), and from medical records. Results: A total of 1252 bone marrow aspirates and biopsies were performed on 914 patients. Seventy-seven complications were reported, which corresponds to 6.15% of all documented procedures. The most frequent complication was: pain (100%), being more affected the women (66%), OR 1,91(IC 1,18-3,11) p=0,003. Regard to pathology diagnosis, 53.2% of biopsies were histologically normal hematopoiesis, followed by 16.8% for chronic myeloproliferative syndromes, which was the diagnosis most commonly associated with bleeding events (40%):OR 8,9 (IC 1,2-66,44) p=0,006, and death (1.3%). Conclusion: Pain was the most frequently reported complication, and among bleeding complications, chronic myeloproliferative disorders were the most common diagnosis. The largest number of complications in women may be related to the anatomical differences between the genders. It is recommended to improve post-procedure analgesia and prospective studies to establish association between complications and diagnosis

Bone marrow examination: a prospective survey on factors associated with pain

Bone marrow examination (BME) represents an essential tool for diagnosis and monitoring of haematological disorders. It remains associated with morbidity and discomfort; repeat examinations are frequent. We made a single-centre prospective survey on 700 BME between July 2007 and July 2008 with a structured anonymized questionnaire for patients undergoing and physicians performing BME, which includes at our institution always aspiration and trephine. All procedures were performed according to institutionalised standard operating procedures; 412 patients' (58.9%) and 554 physicians' (79.1%) questionnaires were returned. Pain was the only procedure-related complication; no pain was reported in 149 (36.7%), bearable pain in 242 (59.6%) and unbearable pain in 15 (3.7%) cases. Premedication associated complications were reported by 110 (32.7%) of the 336 (65.4%) patients with premedication before BME. None of these were > WHO grade 2; most frequently reported were tiredness (76 patients; 22.6%), dizziness (19 patients; 5.7%) and nausea (15 patients; 4.5%). Only two factors were significantly associated with unbearable pain: "pain during prior BME” (seven of 94 with versus one of 198 without previous pain; p < 0.01) and "information before BME” (four of 11 without versus 12 of 372 with adequate information before BME; p < 0.01). Inadequate information at any time showed a trend towards an association with unbearable pain (p = 0.08). No other factor was associated with unbearable pain. Good and adequate information appears to be the best way to reduce pain, even for a future BM

Methods of reducing pain during bone marrow biopsy: a narrative review

Bone marrow examination plays a crucial role in the diagnosis and management of various hematological and systemic diseases. Even though the procedure has been carried out for decades, it remains an extremely painful and uncomfortable experience for a majority of patients. This paper reviews the different strategies used to provide analgesia and summarizes the advantages and drawbacks of one strategy over the other. A literature review was carried out addressing the different approaches to providing pain relief during bone marrow aspiration and biopsy. Several different methods, procedure modifications and protocols are employed at various centers but pain control and analgesia remain incomplete. Local infiltration with lidocaine or similar local analgesics is the standard at most centers. Although there is limited data, there are several studies in literature demonstrating the pain relieving effects of different methods and drugs when used with local anesthetics. Sedation, usually using benzodiazepines, reduces anticipatory anxiety, provides analgesia and also short term amnesia. Combinations of different agents not only yield potent effects but also reduce the required dose of each individual drug, minimizing adverse effects. Non-pharmacological factors also play key roles. Providing patients with complete and comprehensible information is vital to ensure the least amount of discomfort during the biopsy. Distraction techniques, such as cognitive behavioral therapy, hypnosis and music therapy, may also play a role in minimizing pain

Prediction of Bone Marrow Cellularity from Aspiration as compared to Trephine Biopsy

Background: Bone marrow cellularity is an essential and integral part of the bone marrow examination report. Cellularity could be obtained from both bone marrow aspirations and biopsies. Predicting marrow cellularity from aspiration as opposed to biopsy would give the clinician the convenience of an early diagnosis and timely management. In this study, we aimed at knowing the degree of correlation between the bone marrow aspiration cellularity that could be ready within a short period of time to that of bone marrow biopsy cellularity that could take days to have a positive impact on the management, especially for acute blood disorders. Materials and Methods: We collected 200 consecutive bone marrow aspirations from the Nanakaly Teaching Hospital. All the bone marrow biopsy slides belonging to the same group of patients were also collected from the main histology center at Rizgary Teaching Hospital. Five expert hematopathologists were given the chance to report on the cellularity for both the aspirations and the biopsies. The study was performed in sessions, limiting each session to 20 aspirations and 20 biopsies. Cellularity was rated in percentage points of 5 giving the observer the chance to rate the cellularity from 0% to 100%. Results: Microsoft Excel spreadsheet was used to record all the data obtained from the observers. Mean values from all the five observers for each aspiration and biopsy was used for statistical analysis. We found a strong direct positive correlation between the bone marrow biopsy cellularity and bone marrow aspiration cellularity. Conclusion: A simple practical equation could be created to measure bone marrow biopsy cellularity from the usually available aspiration cellularity. Marrow biopsy cellularity was found to be 0.96 of the aspiration cellularity

Haematoma caused by bone marrow aspiration and trephine biopsy

We report a case of a bone marrow aspiration and trephine biopsy (BMATB) associated haematoma in an 85-years old male without any predisposing risk factors. Six days after BMATB, he suffered from a massive thigh and buttock haematoma and a fall in haematocrit. It is important to know that BMATB can have complications aiding early recognition and therapy

Isolated iliac bone tuberculosis : a case report

Background: Isolated iliac bone tuberculosis is not easy for diagnosis as it can mimic many other conditions. The presentation of our case of isolated iliac bone tuberculosis with special emphasis to imaging findings is justified, by its rarity and not uncommon delay in diagnosis and therapy of such cases. Case Report: A case of isolated iliac bone tuberculosis, initially presented with low back pain and swelling, was unsuccessfully treated for three months before final diagnosis was established. Plain radiography revealed only slight sclerosis of the iliac side of the right sacro-iliac joint. MRI provided more precise and detailed information regarding the site, size and nature of the bony and soft tissue components of the lesion. The bony lesion showed low T1, high T2 signal and marginal enhancement on fat suppressed T1 post-gadolinium images. The soft tissue components also showed post-gadolinium enhancement and abscesses formation. CT scan confirmed the bony lytic lesion and provided guidance for biopsy. Histology confirmed tuberculous nature of the lesion. Conclusions: Imaging presentation of tuberculous osteomyelitis is nonspecific and may mimic many inflammatory and neoplastic conditions. Correlation with the patient's history, immune status, ethnicity, social environment is necessary in narrowing differential diagnosis. This means that iliac tuberculosis, despite its rarity, should be considered as one of diagnostic possibilities, especially in the patients from endemic areas. However, definitive diagnosis is best established with bone needle biopsy

Kipu ja ahdistuneisuus aikuispotilailla luuydinnäytteenoton aikana

Background: Bone marrow aspiration and/or biopsy (BMAB) is a procedure used to diagnose and follow up various haematological diseases. It is usually performed at either the sternum or the iliac crest. The procedure often causes pain despite local infiltration anaesthesia. The objective of this study was to evaluate different means of pain relief during BMAB in adult patients. Special attention was paid to pre-procedural anxiety and its effect on pain. The commonly used local anaesthetic lidocaine was compared with articaine, an anaesthetic known for its ability to penetrate bone tissue. The effect of warming and buffering the lidocaine solution, measures expected to improve the anaesthetic action, was examined. Also investigated were sublingual fentanyl and inhaled 50% nitrous oxide (N2O) in oxygen (O2) as means of analgesia and sedation during BMAB. Patients: The patient population comprised 646 adult outpatients from the Department of Haematology, Helsinki University Central Hospital, Finland. Patients were randomized to treatment groups in trials comparing one intervention with another or with placebo. The studies were all patient-blinded. One study was observational and investigated the association between pain and pre-procedural anxiety. Patient recruitment was performed between 2007 and 2014. Main results: Pre-procedural anxiety intensified pain during BMAB in all trials. Median NRS (Numeral Rating Scale, 0 = no pain, 10 = worst pain imaginable) during infiltration was 3.0 (range 0 10, interquartile range (IQR) 3.0), puncture 2.0 (range 0 10, IQR 3.0), aspiration 4.0 (range 0 10, IQR 4.0), biopsy 4.0 (range 0 10, IQR 4.0) and immediately after BMAB 0 (range 0 9.0, IQR 1.0). Scores of 8 10 comprised 8.1%, 4.7%, 13.9%, and 12.4% of the scores for infiltration, puncture, aspiration and biopsy, respectively. Possible supplemental analgesia or sedation given on patient request in addition to local anaesthesia and study intervention did not lower pain scores during BMAB. Articaine was not found to be superior to lidocaine as a local anaesthetic. Warming and buffering the lidocaine solution diminished pain during infiltration, but did not lower the pain scores during other phases of BMAB. Sublingual fentanyl (200 µg or 100 µg) did not provide significant pain relief relative to placebo when administered 6 64 minutes before BMAB. Dizziness was a frequent side-effect. Inhalation of 50% N2O in O2 was no more effective than inhalation of 50% O2. No significant differences in adverse effects emerged between patients receiving N2O/O2 and those receiving 50% O2. Interestingly, 86% of N2O patients and 83% of placebo patients would choose the same analgesia method during their next BMAB. Conclusions: Many patients undergoing BMAB suffer intense pain during the procedure. Pre-procedural anxiety was strongly associated with pain during the various phases of BMAB. The pain from local anaesthetic infiltration with articaine and lidocaine was similar. Buffering and warming the local anaesthetic solution clearly reduced the infiltration pain. However, neither these measures nor the use of sublingual fentanyl or inhalation of N2O had an impact on the pain caused by aspiration and biopsy.Luuydinnäytteenotto on toimenpide, jota tarvitaan erilaisten hematologisten sairauksien diagnostiikassa ja seurannassa. Näyte otetaan yleensä rintalastasta tai lonkkaluun harjanteesta. Toimenpide on usein kivulias paikallispuudutuksesta huolimatta. Tutkimuksen tarkoituksena oli arvioida erilaisia kivunlievitysmenetelmiä aikuispotilailla, joilta otetaan luuydinnäyte. Erityistä huomiota kiinnitettiin toimenpidettä edeltävään ahdistuneisuuteen ja sen vaikutukseen toimenpidekipuun. Yleisesti käytettyä paikallispuudute lidokaiinia verrattiin toiseen puudutteeseen artikaiiniin, jonka tiedetään läpäisevän hyvin luukudosta. Huoneenlämpöisen ja happaman lidokaiiniliuoksen lämmittämisen ja puskuroinnin arvellaan parantavan puudutteen vaikutusta, joten tätä tutkittiin myös. Lisäksi tutkimuksessa arvioitiin kielen alle annostellun fentanyylitabletin sekä hengitettävän 50% typpioksiduulin (ilokaasun) ja hapen seoksen kipua lievittävää ja rauhoittavaa vaikutusta luuydinnäytteenoton aikana. Aineisto koostui 646 HYKS:n hematologian poliklinikan potilaista. Toimenpidettä edeltävä ahdistuneisuus pahensi kipua luuydinnäytteenoton aikana kaikissa tutkimuksissa. Kivunmittausasteikolla 0 10 (Numeral Rating Scale, 0 = ei kipua, 10 = pahin mahdollinen kuviteltavissa oleva kipu) kivun voimakkuuden mediaani puudutuksessa oli 3,0 (vaihteluväli 0 10), pistossa 2,0, (vaihteluväli 0 10), aspiraatiossa 4,0, (vaihteluväli 0 10), biopsiassa 4,0 (vaihteluväli 0 10) ja heti toimenpiteen jälkeen 0 (vaihteluväli 0 9,0). Potilaan mahdollinen muu kipu- tai rauhoittava lääkitys puudutuksen ja tutkimuslääkeintervention lisäksi ei vähentänyt kipua luuydinnäytteenoton aikana. Artikaiini ei ollut lidokaiinia parempi paikallispuudutteena. Lidokaiiniliuoksen lämmittäminen ja puskurointi vähensi puudutuksen aiheuttamaa kipua, mutta ei vaikuttanut toimenpiteen muihin kivuliaisiin vaiheisiin. Kielen alle annosteltu fentanyyli (200 µg tai 100 µg) ei merkittävästi vähentänyt toimenpidekipua lumeeseen verrattuna. Huimaus oli yleinen fentanyylin haittavaikutus. Hengitettävä 50% typpioksiduuli ei ollut tehokkaampi kivunlievityksessä kuin lumekaasuna käytetty 50% happi. Typpioksiduulia saaneille potilaille ei kuitenkaan aiheutunut tilastollisesti merkitsevästi enempää haittavaikutuksia kuin lumekaasua saaneille. Peräti 86% typpioksiduulia ja 83% lumetta saaneista olisivat halunneet saman kaasun seuraavaan näytteenottoon. Monelle potilaalle luuydinnäytteenotto aiheuttaa kovaa kipua. Toimenpidettä edeltävä ahdistuneisuus lisäsi selvästi kipua luuydinnäytteenoton eri vaiheissa. Jatkossa lisäkipulääkitystä tarvitsevat potilaat olisikin hyvä tunnistaa ennalta ja suunnata lisälääkitys heille

An Explorative Study On Factors Associated With Neutropenia Onset And Severity Among Cancer Patients.

Neutropenia ialah satu keadaan apabila kandungan neutrophil dalam darah menjadi kurarg daripada 1500 sel/ μl dan ianya merupakan satu kesan sampingan biasa akibat kemoterapi kanser. Neutropenia is a decreased in the absolute number of neutrophils in the blood to less than 1500 cell/ μl and is a common side effect of cancer chemotherapy