What are the necessary preparations for a patient before undergoing a bone marrow biopsy?

Patient Preparation Before Bone Marrow Biopsy

Bone marrow biopsy requires specific patient preparation including laboratory testing, medication review, and informed consent to ensure safety and diagnostic quality.

Pre-procedure Laboratory Assessment

• Complete blood count (CBC) to assess baseline hematological parameters 1
• Coagulation profile including PT/INR and PTT, especially for patients with suspected coagulation disorders 1
• Pregnancy test for women of childbearing age 1

Medication Management

• Anticoagulation management:

  • Routine interruption of anticoagulation is not consistently recommended as bone marrow biopsy is classified as having low to moderate bleeding risk 2
  • Assessment should be done on a patient-by-patient basis 2
  • For patients on antiplatelet therapy, consider individual bleeding risk factors 3

• Special considerations:

  • Patients with myeloproliferative neoplasms may have acquired von Willebrand syndrome requiring extra vigilance 2
  • Thrombocytopenic patients have higher bleeding risk and may require platelet transfusion if counts are very low 3

Imaging Considerations

• Baseline PET/CT may be recommended for certain conditions like lymphoma staging 4
• CT guidance may be considered for difficult anatomical cases or repeat biopsies after unsuccessful attempts 5

Patient Education and Consent

• Explain the procedure, including:

  • Purpose of the biopsy
  • Procedure steps
  • Expected sensations (pressure, brief pain during aspiration)
  • Local anesthesia administration
  • Potential complications (pain, bleeding, infection) 6

• Obtain written informed consent

Site Preparation

• Position patient appropriately (usually lateral decubitus or prone position)
• Identify anatomical landmarks (posterior iliac crest is most common site)
• Prepare and sterilize the site according to standard antiseptic protocols 6

Post-procedure Instructions

• Apply pressure to biopsy site for 5-10 minutes
• Monitor for bleeding for at least 15-30 minutes post-procedure
• Provide written instructions for site care and when to seek medical attention
• Schedule follow-up appointment for results

Special Considerations

• High bleeding risk patients: Consider prophylactic platelet transfusions for severe thrombocytopenia (platelets <20,000/μL) 3
• Patients with significant cardiac disease: Consider cardiac evaluation before procedure if sternal approach is planned 6
• Patients with prior unsuccessful biopsies: Consider image-guided approach 7, 5

Bone marrow biopsy is generally a safe procedure with very low rates of significant hemorrhage (0.007-1.1%) when proper preparation and technique are employed 2.