Bone Marrow Aspiration and Bone Marrow Biopsy in Children

Bone Marrow Aspiration and Bone Marrow Biopsy in Children

Bone marrow aspiration and bone marrow biopsy are procedures that are done to diagnose blood disorders. Your child may also have one of these procedures to help diagnose infections or some types of cancer.

Bone marrow is the soft tissue that is inside the bones. Blood cells are produced in bone marrow. For bone marrow aspiration, a sample of tissue in liquid form is removed from inside the bone. For a bone marrow biopsy, a small core of bone marrow tissue is removed. These samples are examined under a microscope or tested in a lab.

Your child may need these procedures if he or she has an abnormal complete blood count (CBC). In children, the upper part of the hip bone (iliac crest) is usually the site for bone marrow aspiration or biopsy. In infants, the sample may be taken from the shin bone (tibia).

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Bleeding.
  • Infection.
  • Persistent pain after the procedure.
  • Cracking (fracture) of the bone.
  • Allergic reactions to medicines.

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – have your child stop eating foods.
  • 6 hours before the procedure – have your child stop drinking formula or milk.
  • 4 hours before the procedure – stop giving your child breast milk.
  • 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

  • Ask your child’s health care provider about:
    • Changing or stopping regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do notlet your child take these medicines before the procedure if your child’s health care provider instructs you not to.
  • Your child may be given antibiotic medicine to help prevent infection.

General instructions

  • Plan to take your child home from the hospital or clinic.
  • If your child will be going home right after the procedure, plan to be with your child for 24 hours.
  • Ask your child’s health care provider how your child’s surgical site will be marked or identified.

What happens during the procedure?

  • To reduce your child’s risk of infection:
    • Your child’s health care team will wash or sanitize their hands.
    • Your child’s skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV tube may be inserted into one of your child’s veins.
  • Your child will be given one or more of the following:
    • A medicine to help your child relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make your child fall asleep (general anesthetic).
  • The bone marrow sample will be removed as follows:
    • For an aspiration, a hollow needle will be inserted through your child’s skin and into his or her bone. Bone marrow fluid will be drawn up into a syringe.
    • For a biopsy, your child’s health care provider will use a hollow needle to remove a core of tissue from your child’s bone marrow.
  • The needle will be removed.
  • A bandage (dressing) will be placed over the insertion site and taped in place.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines your child was given have worn off.
  • Your child’s IV tube will be removed, and the insertion site will be checked for bleeding.
  • If your child is of driving age, do notlet your child drive for 24 hours if he or she was given a sedative.

Tell your child’s health care provider about:

  • Any allergies your child has.
  • All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems your child or family members have had with anesthetic medicines.
  • Any blood or bone disorders your child has.
  • Any surgeries your child has had.
  • Any medical conditions your child has.
  • Any recent infections your child has had, including skin infections.

Care After Bone Marrow Aspiration and Bone Marrow Biopsy in Children

What can I expect after the procedure?

After the procedure, it is common for your child to have:

  • Mild pain and tenderness.
  • Swelling.
  • Bruising.

Follow these instructions at home:

Give over-the-counter or prescription medicines only as told by your child’s health care provider.

  • Do notlet your child take baths, swim, or use a hot tub until your child’s health care provider approves. Ask if your child can take a shower or have a sponge bath.
  • Follow instructions from your child’s health care provider about how to take care of the puncture site. Make sure you:
    • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your child’s dressing as told by your child’s health care provider.
  • Check your child’s puncture site every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.
  • Let your child return to his or her normal activities as told by your child’s health care provider. Ask your health care provider what activities are safe for your child.
  • If your child is of driving age, do notlet your child drive for 24 hours if he or she was given a medicine to help him or her relax (sedative).
  • Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

  • Your child has more redness, swelling, or pain around the puncture site.
  • Your child has more fluid or blood coming from the puncture site.
  • Your child’s puncture site feels warm to the touch.
  • Your child has pus or a bad smell coming from the puncture site.
  • Your child has a fever.
  • Your child’s pain is not controlled with medicine.

Get help right away if:

  • Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.
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