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Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients

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Abstract

Purpose

To assess the safety of fluoroscopically guided drill-assisted bone marrow aspirate and biopsy in severely thrombocytopenic patients.

Materials and methods

The study was approved by the IRB with waiver of informed consent. Retrospective review of 111 bone marrow aspirate and biopsies (BMAB) performed in 94 patients who received a CT scan which included the pelvis and biopsy site within the 7 days following the BMAB. The 94 patients were subdivided based on their platelet count: severe thrombocytopenia (< 20 platelets × 109/L), thrombocytopenia (20–50 platelets × 109/L), and control (> 50 platelets × 109/L). The procedure report was reviewed for sedation time, aspirate volume, and aggregate size of core biopsy specimens. The electronic medical record was reviewed for specimen adequacy; pathologic diagnosis; body mass index; pre- and post-procedure labs including platelet count, hemoglobin (HGB), hematocrit (HCT), prothrombin time (PT), and international normalized ratio (INR) levels; post-procedural transfusion; and complications including mortality at 30 and 90 days. CT scans were independently reviewed by 2 fellowship-trained radiologists for the presence of post-procedural hemorrhage.

Results

There was no significant difference in CT-identified post-procedural hematoma, or change in the hemoglobin and hematocrit levels pre- and post-procedure between the three groups. There was no significant difference in complication rate or all-cause mortality. There was a significant difference in transfusion at 30 days with thrombocytopenic and severely thrombocytopenic patients more likely to receive transfusion within the 30 days post-procedure.

Conclusion

Fluoroscopically guided BMAB can be safely performed in patients with severe thrombocytopenia.

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Authors and Affiliations

  1. Department of Radiology, University of Missouri, 1 Hospital Dr., Columbia, MO, 65203, USA

    JD Stensby

  2. Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA

    JR Long

  3. Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA

    TJ Hillen & JW Jennings

Authors
  1. JD Stensby
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  2. JR Long
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  3. TJ Hillen
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  4. JW Jennings
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Corresponding author

Correspondence to JD Stensby.

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Conflict of interest

Stensby JD and Long JR declare that they have no conflict of interest.

Hillen TJ is a consultant for Consultant Medtronic, SI Bone, ERT, and Ultragenyx.

Jennings JW is a consultant for Merit Medical System, Medtronic, Stryker, Bard, and Teleflex Arrow.

Informed consent

The project was approved by the IRB with a waiver of informed consent.

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Stensby, J., Long, J., Hillen, T. et al. Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients. Skeletal Radiol 50, 915–920 (2021). https://doi.org/10.1007/s00256-020-03623-5

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  • DOI: https://doi.org/10.1007/s00256-020-03623-5

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