ASSISTING IN BONE MARROW ASPIRATION

1. define the following terms: 1.1 bone marrow 1.2 bone marrow aspiration 1.3 biopsy 1.4 fibrosis 1.5 hematologist 1.6 hematoma 1.7 hemapoiesis 1.8 hemorrhage 1.9 myeloma

2. review the anatomy and physiology of the bone marrow in relation to hematopoiesis 3. state the purpose to bone marrow aspiration

4. enumerate the common sites of bone marrow aspiration

5. discuss the ff about BMA 5.1 indications and contraindications 5.2 complication 5.3 nursing responsibilities involved before, during and after assisting in BMA 6. differentiate the normal and abnormal results of BMA 7. demonstrate beginning skills in assisting in BMA

1. Definition of terms: Bone marrow- the soft, organic, sponge like material in the cavities of the bone

Bone marrow aspiration - Bone marrow aspiration is the removal by suction of fluid from the soft, spongy material that lines the inside of most bones. Bone marrow biopsy, or needle biopsy, is the removal of a small piece of bone marrow.

Biopsy- The removal and examination of tissue, cells, of fluids from the living body Fibrosis- An abnormal condition in which fibrous connective tissue spreads over or replaces normal smooth muscles or other normal organ tissue.

Hematologist-A medical specialist who treats diseases and disorders of the blood and blood-forming organs. Hematoma- a mass of usually clotted blood that forms in a tissue, organ or body space as a result of a broken blood vessel

Hemapoiesis - the formation of blood cells Hemorrhage- a rapid or uncontrollable loss or outflow of blood Myeloma- a primary tumor of the bone marrow

2. Anatomy and Physiology of Bone Marrow in Relation to Hematopoiesis The bone marrow is the 5th largest organ of the human body. Its chief function is hematopoietic, providing the optimal supply of circulating platelets, white and red blood cells to meet the bodys requirements for coagulation, immunity, and oxygenation. The histology of normal bone marrow consists of a number of components including: (1) an osseous component; (2) a cellular component; (3) a supporting system. The osseous component consists of cancellous bone composed of primary and secondary trabeculae. The cellular component includes hematopoietic, fat, and reticulum cells. The bone marrow supporting system consists of vascular, neural, and lymphatic elements. Hematopoietically active bone marrow is referred to as hematopoietic marrow or red marrow. Red marrow contains approximately 40% water, 40% fat, and 20% protein. Hematopoietically inactive marrow is referred to as yellow marrow or fatty marrow. It contains approximately 15% water, 80% fat, and 5% protein. These differences in chemical composition account for the appearance of red and yellow marrow on various MRI pulse sequences. There is also a structural difference between red and yellow marrow. In particular, the vascular network of red marrow can be characterized as being rich, while that of yellow marrow is more sparse.

3. Purpose of Bone Marrow Used as laboratory examinations of RBC, WBC, platelets, stem call transplantation or chromosomal analysis Diagnose infection and hematologic disorders Examine bone marrow for presence of fibrotic tissue or neoplasm

Pinpoint the cause of abnormal blood cells Confirm a diagnose or check the status of severe anemia of unknown cause or their irregularities in the production and maturation of blood cells Evaluate abnormalities in the bodys ability to store iron

4. Enumerate Common Sites of Bone Marrow Iliac crest (posterior or anterior) o Posterior superior iliac crest: This is the most commonly employed site for reasons of safety, a decreased risk of pain, and accessibility. The posterior superior iliac crest site is localized to the central crest area.

Anterior superior iliac crest: This is an alternative site when the posterior iliac crest is unapproachable or not available due to infection, injury, or morbid obesity. The anterior superior iliac crest site is localized to the center prominence, under the lip of the crest. This location is generally not preferred due to the dense cortical layer, which makes obtaining samples more difficult and smaller in size, as well as creates a risk for an increased painful event.

Sternum (between the 2nd and 3rd ribs) o Sternal puncture does not present a danger of injury to the underlying structures in the mediastinum if penetration is too deep

5. A. Indications and Contraindications Indications: 1. Confirm the diagnosis of megaloblastic anemia 2. To diagnose leukemia or myeloma 3. To determine if the marrow is the cause of reduced blood cells in the peripheral bloodstream 4. To document deficient iron stores 5. To document bone marrow infiltrative diseases (neoplasm or fibrosis) 6. It is also used as testing for lymphomas

Contraindications: 1. Patients with acute coagulation disorders, because of the risk of excessive bleeding 2. Patients who cannot cooperate and remain still during the procedure 3. Patients who are not pregnant 4. Patients who are allergy to medications (e.g. Lidocaine) B. Complication 1. Hemorrhage 2. Infection 3. Sternal Fracture 4. Inadvertent puncture of the heart or great vessels when the test is performed on the sternum

C. Nursing Responsibilities before, after and during BEFORE Explain to the patient the procedure, it is essential so that the nurse can allay apprehension and gain the patients cooperation in lying still during the procedure. Inform the client that they will feel pressure when the physician aspirates the bone marrow. Appropriate supplies and equipments should be carried to the patients bedside. Aseptic technique in handling and assisting, be alert and assist correctly.

DURING AFTER Assess the site of bleeding after the procedure is completed. The client should remain on bed rest for at least 30 minutes after the test. The labeled specimen is placed immediately in a jar containing a preservative, such as sodium oxalate and sent to the laboratory. After applying pressure at the puncture site for a few minutes or a minimum of 5 minutes if the patient is thrombocytopenic, the nurse applies a small dressing or Band-Aid. Assure patient that it is normal to feel a slight soreness on the puncture site for several days. The patient, particularly one who is thrombocytopenic, is instructed not to remove or wet the dressing for 24 hours and is monitored for continual bleeding at the site Instruct the patient to lie still during the procedure

6. Normal and Abnormal Results of Bone Marrow Normal Results A normal result means the bone marrow contains the proper number and types of bloodforming (hematopoietic) cells, fat cells, and connective tissues. Healthy adult bone marrow contains yellow fat cells, connective tissue, and red marrow that produce blood. The bone marrow of a healthy infant is primarily red due to active production of red cells necessary for growth.

Abnormal Results Abnormal results typically include too few red blood cells, too few platelets or abnormal white blood cells. Doctors use these abnormal results to decide which type of treatment will be most effective for the patient's condition.

Culture of bone marrow aspirate may yield information about an infectious agent. Microscopic examination of bone marrow can reveal granulomas, myelofibrosis, lymphomas, leukemia, or other cancers. Analyzing specimens can help doctors diagnose iron deficiency, vitamin B12 deficiency, and folate deficiency, as well as anemia. Obesity can affect the ease with which a bone marrow biopsy can be done, and the results of either procedure can be affected if the patient has had radiation therapy at the biopsy site. 7. Demonstrate Beginning Skills