A Teachable Moment in Minimizing Morbidity with Bone Marrow Biopsy Procedures

Document Type : Brief Report

Authors

1 Corewell Health William Beaumont Hospital

2 Department Of Hematology/Oncology, Corewell Health/Royal Oak.

3 Department Of Nuclear Medicine, Corewell Health/Royal Oak.

4 Department Of Pathology, Corewell Health/Royal Oak.

10.22038/psj.2024.82174.1440

Abstract

For adults, the iliac crest is the preferred site for bone marrow biopsy and aspiration. Attention to detail in the placement of the incision are necessary to obtaining an adequate specimen and avoiding injury in patients. In addition, awareness of the height and rotational position of the patient’s hips is important to prevent injury and need for repositioning during the procedure. We report a case where the biopsy needle was at an unusual angle that placed the patient at risk for retroperitoneal bleeding. Uniquely, the patient also had a Positron Emission Tomography (PET) scan done the next day and was noted to have an awkward trajectory that could have led to a hematoma or retroperitoneal bleeding. It was clear that if the operator continued to use this approach, it would put future patients at greater risk for morbidity. This unique case led to identification of a "near-miss" event and motivated the re-training of bone marrow biopsy operators.

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References

  1. Foucar, K. (2020). Bone Marrow Pathology (4th ed., pp. 49-61). ASCP Press.
  2. Bain, B. J. (2006). Morbidity associated with bone marrow aspiration and trephine biopsy: A review of UK data for 2004. Haematologica, 91(9), 1293-1294.
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  4. Neese, A. (2009). Clinical management of massive retroperitoneal hemorrhage after bone marrow biopsy. Leuk Lymphoma, 50(3), 475-477.
  5. Bain BJ. Bone marrow biopsy morbidity: review of 2003. J Clin Pathol 2005; 58:406–408.

 

Journal of Patient Safety & Quality Improvement
Volume 12, Issue 4
October 2024
Pages 173-175

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