A Teachable Moment in Minimizing Morbidity with Bone Marrow Biopsy Procedures

For adults, the iliac crest is the preferred site for bone marrow biopsy and aspiration. Attention to detail in the placement of the incision are necessary to obtaining an adequate specimen and avoiding injury in patients. In addition, awareness of the height and rotational position of the patient’s hips is important to prevent injury and need for repositioning during the procedure. We report a case where the biopsy needle was at an unusual angle that placed the patient at risk for retroperitoneal bleeding. Uniquely, the patient also had a Positron Emission Tomography (PET) scan done the next day and was noted to have an awkward trajectory that could have led to a hematoma or retroperitoneal bleeding. It was clear that if the operator continued to use this approach, it would put future patients at greater risk for morbidity. This unique case led to identification of a "near-miss" event and motivated the re-training of bone marrow biopsy operators.