In the adult patient, the iliac crest is the site of choice, and the patient is usually face down while the physician chooses an appropriate area. The area is anesthetized with local anesthesia for an appropriate amount of time and the physician proceeds to advance the aspirate needle with a twisting, downward motion11 (Fig. 2.4). Once the needle has seeded into the marrow, its position is solid and not moveable. The stylus is removed and a syringe is placed at the end of the needle. With a quick motion, a small amount of bloody fluid (approximately 1 mL) and marrow spicule material is obtained. The technologist/technician assesses the sample for bone marrow, communicates to the physician whether marrow is observed, and then proceeds to prepare slides from the aspirate material, fishing out bone marrow spicules with a microbiologic loop or pipette. If a biopsy sample is requested, the cutting blade is introduced into the bore of the needle and advanced until the medullary cavity is entered. A very small core of bone, 3/4 in., is obtained, and the biopsy sample is removed by inserting a stylus into the cutting blade and pushing the sample through the open end. The procedure is terminated as the physician withdraws the needle and applies pressure to the area. Touch preparation of the core biopsy is made by the technologist by gently applying the biopsy sample to several coverslips with the use of sterile tweezers. In the event that an aspirate cannot be obtained, this may present a viable option. The remaining aspirate and biopsy material are placed in a 5% Zenker's fixative and processed in the histology laboratory. The patient should remain in bed for the next hour so that pressure is applied to the aspirate location. Patients with decreased platelet counts may need to be monitored more closely and have pressure exerted on the biopsy site for longer periods once the procedure is completed.
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