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ASSIGNMENT

ON
BONE MARROW
ASPIRATION

SUBMITTED TO; SUBMITTED BY:

Mrs. M.Jothimalar .M.sc nursing Mrs. N. Anantha packiam


Associate Professor M.Sc Nursing I St Year
Department Of MSN Rass Academy College Of
RACN, Madurai.. Nursing, Madurai
BONE MARROW ASPIRATION

DEFINITION

Bone marrow aspiration, also called Bone Marrow Sampling, is


the removal by suction of the soft, spongy semisolid tissue (marrow) that fills
the inside of the long and flat bones. Bone marrow biopsy, or needle core
biopsy, is the removal of a small piece (about 0.75 X 0.06 in, or 2 X 0.16 cm) of
intact bone marrow. The bone marrow is where blood cells are made.

PURPOSES

 Examination of the bone marrow may be the next step that follows an
abnormal clinical finding, such as an abnormal complete blood count
(CBC), and/or an abnormal peripheral blood smear.
 It may also be performed following an abnormal bone image such as the
finding of a lesion on x rays.
 A biopsy of bone marrow shows the intact tissue, so that the structure of the
fat cells, lymphocytes, plasma cells, fibrous connective tissue cells, and
other cells, and their relationships to each other, can be seen.

INDICATIONS
 To evaluate the unusual peripheral blood finding, thrombocytopenia,
unexplained anemia, and pancytopenia.
 To investigate hypoplastic anemia, malignant hematological disorders,
metastatic expansion of tumours, and congenital bone marrow deficiency
syndrome
 To achieve the cultures of bone marrow especially in case of infection of
unknown origin.
 For evaluation of abdominal masses, lymphadenopathy, and hypersplenism.
 To follow up the chemotherapy or transplantation of hematopoietic stem
cells
Clinical Indication - Bone Marrow Biopsy:

The common clinical indications for BMB in children are as follows:

a) Insufficient or failure of BMA

b) .Suspected BMF (bone marrow fibrosis).

c) Staging and evaluation of non-Hodgkin’s and Hodgkin’s lymphoma,


and Ewing’s sarcoma as well as tiny blue oval cell tumours associated
with childhood (rhabdo-myosarcoma, neuroblastoma).

d) Detection of myelodysplastic syndromes, aplastic anaemia, and


AML(Acute Megaloblastic leukaemia) .

Contraindications

a) Haemorrhagic disorders (eg., haemophilia),

b) Infection of skin or earlier radiation therapy at the site of aspiration


sampling.

c) Bone disorders like osteogenesis imperfecta or osteomyelitis .

A Bone Marrow Biopsy Is Used To:


 Diagnose and manage any form of leukemia or other
myeloproliferative condition such as multiple myeloma
 Rule out or confirm bone marrow infiltration by malignancies such
as hodgkin's disease, non-hodgkin's lymphoma, and metastatic
carcinoma
 Monitor the effects of chemotherapy and the response or lack of
response to treatment of blood disease
 Evaluate the success of bone marrow transplantation
 Diagnose certain genetic diseases (e.g., lipid storage disease)
 Investigate pancytopenia (a decrease of all blood cells in peripheral
blood), neutropenia (decreased phagocytic white blood cells), or
thrombocytopenia (decreased platelets)
 Diagnose an infection of unknown origin
 Investigate rare anemias for which a cause cannot be found or which
does not respond to treatment as anticipated
 Obtain intact bone marrow for laboratory analysis
 Diagnose some types of cancer or anemia and other blood disorders
 Identify the source of an unexplained fever (e.g., granulomatous lesions)
 Diagnose fibrosis of bone marrow and myeloma when bone marrow
aspiration has failed to provide an appropriate specimen

DIAGNOSIS/PREPARATION

 The physician should be informed of any medication the patient is using


and any heart surgery that the patient may have undergone.

 Adults require no special preparation for this test. As for infants and
children, they need physical and psychological preparation depending on
the child's age, previous medical experiences, and level of trust.

Infant preparation
 Before the test, parents should know that their child will most probably
cry, and that restraints may be used.

 To provide comfort, and help their child through this procedure, parents
are commonly asked to be present during the procedure. Crying is a
normal infant response to an unfamiliar environment, strangers,
restraints, and separation from the parent.
 Infants cry more for these reasons than because they hurt.

 An infant will be restrained by hand or with devices because they have


not yet developed the physical control, coordination, and ability to
follow commands as adults have.

 The restraints used thus aim to ensure the infant's safety.


Toddler preparation

Parents should prepare a toddler for bone marrow aspiration directly


before the procedure, because toddlers have a very short attention span. Some
general guidelines for parents include the following:

 Explain the procedure in a simple language, using concrete terms


and avoiding abstract terminology.
 Make sure that the child understands where on his body the procedure
will be performed and that it will be limited to that area.
 Allow the child to yell, cry, or express anything, especially pain, verbally.
 Describe how the test will feel.
 Stress the benefits of the procedure and anything that the child may
find enjoyable afterwards, such as feeling better or going home.

Preschooler preparation

Parents should prepare a preschooler for bone marrow aspiration


directly before the procedure, so that the child does not worry about it for days in
advance. Explanations should be limited to 10 or 15 minutes, because
preschoolers also have a limited attention span. Parents should also ensure that
the child understands that the procedure is not a punishment. Some general
guidelines for parents include the following:
 Explain the procedure in a simple language, using concrete terms
and avoiding abstract terminology.
 Make sure that the child understands where on his or her body the
procedure will be performed and that it will be limited to that area.
 Allow the child to yell, cry, or express anything, especially pain, verbally.
 Describe how the test will feel and be honest about any pain that may be
felt.
 Allow the child to practice different positions or movements that
will be required for the procedure.
 Stress the benefits of the procedure and anything that the child may
find enjoyable afterwards, such as feeling better or going for a treat
on the way home.
 Practice deep breathing and other relaxing exercises. Practice also to
have the child hold your hand and tell him or her to squeeze it when he
or she feels pain during the procedure.

School-age child preparation


Explanations should be limited to 20 minutes, and repeated if
required. School-age children have a good concept of time, allowing for
preparation in advance of the procedure. The older the child, the earlier a parent
can start preparation. Guidelines for parents include the ones provided for
preschoolers as well as the following:
 Suggest ways for maintaining control during the procedure. For
example, counting, deep breathing, and relaxation (thinking of
pleasant thoughts).
 Include the child in the decision-making process, for example, the time
of day or the body site where the procedure will be performed.
 These of course depend on the scheduling constraints of your physician
and the type of procedure being performed, but where possible, involve
the child in the decisions.
 Encourage the child to participate in the procedure, for example by holding
an instrument, if allowed by the attending hospital staff.
 Encourage the child to hold your hand or the hand of a nurse. Physical
contact does help reduce pain and anxiety.
Adolescent preparation

 An adolescent is best prepared by being provided with detailed


information and reasons for the procedure.
 Adolescents should be encouraged to make as many decisions as
possible. An adolescent may or may not wish a parent to be present
during the procedure, and such wishes should be respected, since
privacy is important during adolescence.
 Other guidelines include the following:
 Explain the procedure in correct medical terminology, and provide the
reason for it.
 Ask the physician about the specific reason if you are not sure.
 To the best of your ability, describe the equipment that will be
involved in concrete terms.
 Discuss potential risks because adolescents are usually quite concerned
about any effects on appearance, mental function, and sexuality. These
concerns should be addressed honestly and openly.

AFTERCARE

1. After the needle is removed, the biopsy site is covered with a clean, dry
pressure bandage.
2. The patient must remain lying down and is observed for bleeding for one
hour. The patient's pulse, breathing, blood pressure, and temperature are
monitored until they return to normal.
3. The biopsy site should be kept covered and dry for several hours.
4. The patient should be able to leave the clinic and resume most normal
activities immediately.
5. Patients who have received a sedative often feel sleepy for the rest of the
day; so driving, cooking, and other activities that require clear thinking
and quick reactions should be avoided.
6. Walking or prescribed pain medications usually ease any discomfort felt
at the biopsy site, and ice can be used to reduce swelling.
A doctor should be notified if the patient:

 Feels severe pain for more than 24 hours after the procedure
 Experiences persistent bleeding or notices more than a few drops of
blood on the wound dressing
 Has a temperature above 101°f (38.3°c)
 Inflammation and pus at the biopsy site and other signs of infection
Risks

 A small amount of bleeding and moderate discomfort often occur at the


biopsy site.
 Rarely, reactions to anesthetic agents, infection, and hematoma (blood
clot) or hemorrhage (excessive bleeding) may also develop.
 In rare instances, the heart or a major blood vessel is pierced when
marrow is extracted from the sternum during bone marrow biopsy.
 This can lead to severe hemorrhage.

NORMAL RESULTS

 Healthy adult bone marrow contains yellow fat cells, connective tissue,
and red marrow that produces blood.
 Bone marrow is evaluated for cellularity, megakaryocyte production, M:E
ratio, differential (classification of blood forming cells), iron content,
lymphoid, bone, and connective tissue cells, and bone and blood vessel
abnormalities.
 The bone marrow of a healthy infant is primarily red (75–100%
cellularity), but the distribution of blood forming cells is very different
than adult marrow. Consequently, age-related normal values must be used.
 Microscopic examination of bone marrow can reveal leukemia,
granulomas, myelofibrosis, myeloma, lymphoma, or metastatic cancers,
bone marrow infection, and bone disease.

BIBLIOGRAPHY
 WWW.GOOGLE.COM
 www.slideshare.net

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