Purpose: 
To collect bone marrow fluid or bone marrow tissue from the iliac bone for pathological, chromosomal or genetic examination to understand the hematopoietic function and cell types of the bone marrow as a basis for diagnosis and treatment.
 
Pre-examination Preparations: 
  1. The physician explains to a pediatric patient and family members the purpose, procedures and precautions.
  2. The legal representative completes the examination/anesthesia consent form.
  3. A pediatric patient who needs general anesthesia should start fasting 8 hours before the examination to avoid aspiration pneumonia caused by vomiting; a pediatric patient receiving local anesthesia can eat normally.
  4. Before the examination, a patient should be assisted in emptying the bladder. 
 
Examination Procedures: 
  1. A pediatric patient will be examined in treatment room of the ward, and his/her family members can wait in the ward. After the examination is completed, the medical and nursing personnel will send the pediatric patient back to his/her room.
  2. The physician will consider whether a pediatric patient needs to receive general or local anesthesia as needed.
  3. During the examination, placing the pediatric patient in the prone position and expose the buttocks to facilitate disinfection and examination (see figure 1).
    f956806e107c9a5f38d994230d74f83b.jpg
    Figure 1
  4. There may be soreness or numbness during the examination, and the medical and nursing personnel will always observe the response of a pediatric patient and provide assistance.
 
Post-examination Precautions:
  1. A pediatric patient should be in the supine position for 1~2 hours and the puncture wound should be pressurized until there is no bleeding (as shown in Figure 2). If there is bleeding in the wound, please inform the medical and nursing personnel immediately.
    557a3525bfccd9c2637710c6ba4c0a14.jpg
    Figure 2
  2. If a pediatric patient receives general anesthesia, the head must be turned sideways to prevent inhalation of vomit.
  3. After confirming that a pediatric patient is awake, a small amount of boiled water can be given first, and then the patient can eat normally when there is no cough after drinking water.
  4. To prevent infection of the wound, the wound must not be exposed to water within 24 hours after the examination. If the wound gets wet accidentally, the patient must inform medical and nursing personnel immediately.
  5. The gauze can be removed 1~2 days after the examination. If you find that the wound is bleeding again or if there are secretions, please inform the medical and nursing personnel immediately.
  6. It is normal for the wound soreness to occur within 2~3 days after the examination. If the pain time is prolonged or the pain is intolerable, please notify medical and nursing personnel immediately.
 
Reference 
  1. Sahoo, S. R., Mohanty, P., Bhuyan, P., Nayak, M., & Das, B. P. (2017). Bone marrow biopsy in evaluation of haematological disorders. Journal of Evidence Based Medicine and Healthcare, 4(28), 1623-1629. doi:10.18410/jebmh/2017/317
  2. Tseng, T. H., Liang, S. H., Lin, M. H., Wu, S. Y., Wang, K. C., Liu, C. C., … Chen, Y. C. (2017). Care for children with cancer. Chief reviewer Chen, Y. C., Practical Pediatric Care (8th Edition, pp. 941-1012). Taipei: Farseeing Publishing. 
  3. Zehnder, J. L. (2020). Bone marrow aspiration and biopsy: Indications and technique. In A. G. Rosmarin (Ed.), UpToDate. Retrieved February 18, 2020, from http://www.uptodate.com/contents/bone-marrow-aspiration-and-biopsy-indications-and-technique
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