Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients
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SCIENTIFIC ARTICLE
Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients JD Stensby 1
&
JR Long 2 & TJ Hillen 3 & JW Jennings 3
Received: 8 July 2020 / Revised: 11 September 2020 / Accepted: 20 September 2020 # This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract Purpose To assess the safety of fluoroscopically guided drill-assisted bone marrow aspirate and biopsy in severely thrombocytopenic patients. Materials and methods The study was approved by the IRB with waiver of informed consent. Retrospective review of 111 bone marrow aspirate and biopsies (BMAB) performed in 94 patients who received a CT scan which included the pelvis and biopsy site within the 7 days following the BMAB. The 94 patients were subdivided based on their platelet count: severe thrombocytopenia (< 20 platelets × 109/L), thrombocytopenia (20–50 platelets × 109/L), and control (> 50 platelets × 109/L). The procedure report was reviewed for sedation time, aspirate volume, and aggregate size of core biopsy specimens. The electronic medical record was reviewed for specimen adequacy; pathologic diagnosis; body mass index; pre- and post-procedure labs including platelet count, hemoglobin (HGB), hematocrit (HCT), prothrombin time (PT), and international normalized ratio (INR) levels; post-procedural transfusion; and complications including mortality at 30 and 90 days. CT scans were independently reviewed by 2 fellowship-trained radiologists for the presence of post-procedural hemorrhage. Results There was no significant difference in CT-identified post-procedural hematoma, or change in the hemoglobin and hematocrit levels pre- and post-procedure between the three groups. There was no significant difference in complication rate or all-cause mortality. There was a significant difference in transfusion at 30 days with thrombocytopenic and severely thrombocytopenic patients more likely to receive transfusion within the 30 days post-procedure. Conclusion Fluoroscopically guided BMAB can be safely performed in patients with severe thrombocytopenia. Keywords Bone marrow biopsy . Thrombocytopenia
Introduction Bone marrow aspiration and biopsy (BMAB) is an essential diagnostic tool in the assessment of unexplained hematologic abnormalities [1, 2]. The posterior iliac bone is the preferred access site for marrow aspiration due to its superficial
* JD Stensby [email protected] 1
Department of Radiology, University of Missouri, 1 Hospital Dr., Columbia, MO 65203, USA
2
Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
3
Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
location, the ability to simultaneously obtain a biopsy, and the lack of overlying neurovascular structures [3]. Complications following BMAB are rare. Survey data from the British Society of Haematology shows a complication rate of 0.08–0.12% [4, 5]. Post-procedural he
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