Performing bone marrow aspiration and biopsy in children: Recommended guidelines

Bone marrow aspiration (BMA) and bone marrow trephine biopsy are important procedures for the diagnosis of hematological malignancies and nonmalignant diseases in children. During BMA, bone marrow particles are obtained for analysis including microscopic morphologic evaluations and differential counts. During a trephine biopsy, a core of bone marrow is obtained and processed for the evaluation of marrow cellularity and to rule out marrow involvement by solid tumours, lymphomas or other processes. These invasive procedures should only be performed by a trained individual following a standard operating technique. There are no clear published guidelines in the paediatric literature. Hence, the purpose of the present article is to provide guidelines for the performance of BMAs and bone marrow trephine biopsies in children that will be useful for both general paediatricians and paediatric hematologists and oncologists.