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Aspiration of bone marrow from iliac crest (child)

General

The cells in the blood and lymphatic system, in general, originate from stem cells in the bone marrow. In lymphoma and leukemia, as well as in some other tumors, a bone marrow examination is performed. In pediatrics, an aspiration and/or biopsy is taken from the iliac crest (hip bone). When doing a work-up for Hodgkin's lymphoma and some solid tumors, an aspirate and biopsy are taken from both sides. Sternal punctures are not performed on children.  

In children, a bone marrow puncture is almost always performed under general anesthesia.

A bone marrow examination includes

  • A smear for the primary work-up and later for monitoring of treatment response for leukemia or for evaluation of marrow involvement from lymphomas/solid tumors
  • Aspirate samples for flow cytometry, cytogenetics, molecular genetics testing, and sometimes for research studies
  • Biopsy
  • Peripheral blood smear 

For diagnostics, the following is performed:

  • Immunophenotyping (marker testing) using flow cytometry
  • Cytogenetics (chromosome testing)
  • Molecular genetic testing (for example PCR: polymerase chain reaction, FISH: fluorescence in situ hybridization) 
  • Special tests for research studies

Indications

Evaluation for:

  • Lymphoma and leukemia
  • Serious anemia
  • Thrombocytopenia
  • Ambiguous bone pain/rheumatic symptoms
  • Fever that is ambiguous
  • Testing for possible tumor metastases in bone marrow
  • Assessment of treatment effect 

The only contraindication for a bone marrow biopsy is serious hemophilia. In this case, it must be performed in collaboration with a hemophilia clinic.   

If treating with warfarin, INR should be ≤ 3.

NSAID/ASA treatment does not need to be postponed. Be aware of possible thrombocytopenia.

Goal

  • Diagnose or exclude disease involvement of bone marrow
  • Monitor response to treatment

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