From the Research
Bone marrow biopsies should never be performed with the intention of penetrating arteries, as this would be dangerous and potentially life-threatening. The standard sites for bone marrow biopsy are the posterior iliac crest (most common), anterior iliac crest, and in some cases the sternum (aspiration only, not core biopsy). These sites are specifically chosen because they avoid major blood vessels. The posterior iliac crest is preferred because it provides safe access to bone marrow while minimizing the risk of vascular injury. During the procedure, the needle is directed away from the gluteal vessels and sciatic nerve. If a biopsy is performed incorrectly, it could potentially damage nearby vessels such as the superior gluteal artery near the iliac crest or internal thoracic arteries near the sternum, but this would be a serious complication rather than an intended target. Proper technique, anatomical knowledge, and imaging guidance when necessary are essential to ensure the procedure is performed safely without vascular injury.
Key Considerations
- The risk of vascular injury is low, but it can be serious, as reported in a case of pseudoaneurysm of the superior gluteal artery after a bone marrow biopsy 1.
- A study on the management of bone marrow biopsy-related bleeding risks found that thrombocytopenic patients have a non-negligible bleeding risk, but coagulation profiling seems irrelevant 2.
- Inadvertent vascular injury can be managed with rescue embolization techniques, as illustrated in a case report on concomitant internal iliac arterial and venous injuries by a bone marrow biopsy needle 3.
- Improper biopsy tracts are common in palpation-guided iliac bone marrow biopsy and are significantly associated with complications, including bleeding, as reported in a retrospective study 4.
Recommendations
- Perform bone marrow biopsies with proper technique and anatomical knowledge to minimize the risk of vascular injury.
- Use imaging guidance when necessary to ensure safe access to bone marrow.
- Be aware of the potential risks of vascular injury and have a plan in place for managing complications, including rescue embolization techniques.
- Consider the patient's individual risk factors, such as thrombocytopenia, when assessing the risk of bleeding complications 2.