Bone Marrow Aspiration

Indications
Evaluation of unexplained anemia,thrombocytopenia,leukopenia Evaluation of unexplained leukocytosis, thrombocytosis; search for malignancy primary to the marrow or metastatic to the marrow Evaluation of iron stores; Evaluation of possible disseminated infection (TB, fungal disease) Bone marrow donor harvesting

Contraindications
Infection, osteomyelitis near puncture site Relative contraindications:
Severe coagulopathy and thrombocytopenia Previous radiation to the region

Procedure
1. Explain the procedure to the patient and/or guardian 2. Bone marrow can be obtained from numerous sites, such as the sternum and anterior or the posterior iliac crest is the safest and the site of choice. Position the patient on the side opposite the side from which the biopsy specimen is to be taken. 3. Identify the posterior iliac crest by palpation and mark the desired biopsy site with indelible ink. 4. Use sterile gloves, mask, and gown, and follow strict aseptic technique.

BMA Procedure

Complications
Local bleeding and hematoma Retroperitoneal hematoma Pain Bone fracture Infection

Injection Techniques
Subcutaneous injections

Indications
Intradermal: Most commonly used for skin testing (eg, PPD) Subcutaneous: Useful for low-volume medications such as insulin, heparin, and some vaccines Intramuscular: Administration of parenteral medications that cannot be absorbed from the SQ layer or of high volume ( 10 mL)

Contraindications
Allergy to any components of the injectate Active infection or dermatitis at the injection site Coagulopathy (IM injections)

Subcutaneous Injection Procedure

1. Choose a site free of scarring and active infection. Injection sites include the outer surface of the upper arm, anterior surface of the thigh, and lower abdominal wall. 3. 2527 gauge 1 in (22.5 cm) needles are most commonly used; volume of medication must not exceed 5 mL. Draw up the medication, making certain to expel any air bubbles. 4. Clean the site with an alcohol swab. Bunch up the skin with your thumb and forefinger so that the SQ tissue is off the underlying muscle. 5. Warn the patient that there will be "pinch" or "sting," and insert the needle firmly and rapidly at a 45-degree angle until a sudden release signifies penetration of the dermis. 6. Release the skin, aspirate to make certain a blood vessel has not been entered, and inject slowly. 7. Withdraw the needle and apply gentle pressure. Activate the automatic needle shield, discard the needle.

Complications
Nerve and arterial injury Abscesses (sterile or septic). Use good technique and rotate injection sites. Bleeding can usually be controlled with pressure.