Retroperitoneal Hematoma after Bone Marrow Biopsy: The First Cut Should Not Be the Deepest

Wojciechowski, Andrej; Duckert, Martin; Hartmann, Jens; Bullinger, Lars; Matzdorff, Axel

doi:10.1159/000499743

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Results of bone marrow biopsies following therapy are important, as they guide the treatment plan [27]. When performed by trained personnel, the procedure is safe, but it remains uncomfortable and can be associated with pain and, less often, with bleeding and infections [28][29][30][31][32][33][34][35][36]. In children with AML and in some adult patients with AML, sedation/anesthesia is required for performing the biopsy, and there is always the possibility that the biopsy specimen is not adequate for evaluation [37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Blast-Derived Small Extracellular Vesicles in the Plasma of Patients with Acute Myeloid Leukemia Predict Responses to Chemotherapy

Boyiadzis,

Hong,

Yerneni

et al. 2023

Biomedicines

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The small extracellular vesicles (sEV) accumulating in acute myeloid leukemia (AML) patients’ plasma are mixtures of vesicles produced by leukemic and non-malignant cells. sEV originating from leukemia blasts could serve as potential non-invasive biomarkers of AML response to therapy. To isolate blast-derived sEV from patients’ plasma, we developed a bioprinted microarray-based immunoassay using monoclonal antibodies (mAbs) specific for leukemia-associated antigens (LAAs) and mAbs specific for a mix of tetraspanins (CD9, CD63, and CD81). We determined the proportion of LAA+ sEV relative to total plasma sEV (the LAA+/total sEV ratio) in serially collected samples of newly diagnosed AML patients prior to, during, and after chemotherapy. At AML diagnosis, the LAA+/total sEV ratio was significantly higher in patients than in healthy donors (HDs). In patients who achieved complete remission (CR) after induction chemotherapy, the LAA+/total sEV ratios significantly decreased after each chemotherapy cycle to levels seen in HDs. In contrast, the LAA+/total sEV ratios in AML patients with persistent leukemia after therapy remained elevated during and after therapy, as did the percentage of leukemic blasts in these patients’ bone marrows. The LAA+/total sEV ratio emerges as a promising non-invasive biomarker of leukemia response to therapy.

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Section: Discussionmentioning

confidence: 99%

Blast-Derived Small Extracellular Vesicles in the Plasma of Patients with Acute Myeloid Leukemia Predict Responses to Chemotherapy

Boyiadzis,

Hong,

Yerneni

et al. 2023

Biomedicines

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“…Only one major bleeding event (0.03%) was recorded in a patient with essential thrombocytosis and a platelet count of >1200 x 10 9 /L at the time of biopsy. Another study showed that from 30 reported cases of major bleeding events following bone marrow biopsy, 6 (20%) were on anticoagulation and 10 (33%) had a diagnosis of MPN 22 . Therefore, available literature, although limited, does not indicate that the use of anticoagulant and/or antiplatelet agents is associated with a strong risk of bleeding in patients undergoing bone marrow biopsy.…”

Section: Management Of Antithrombotic Agentsmentioning

confidence: 99%

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

Wang

Sanfilippo

Douketis

et al. 2022

Journal of Thrombosis and Haemostasis

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Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable.In this document, the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis aims to provide useful practice guidance in the management of antithrombotic agents and thrombocytopenia around the time of common procedures in patients with cancer.

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“…In addition to the aggregate studies described above, there were approximately 30 case reports that described severe bleeding following BM biopsy. Most (but not all) are summarized by Wojciechowski [6]. Of the case studies, six reported the patient being anticoagulated.…”

Section: Bleeding After Bm Biopsymentioning

confidence: 99%

Anticoagulation and bone marrow biopsy: is it safe to proceed?

Moore

Kotchetkov

2021

Hematology

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Background: Bone marrow (BM) biopsy is the most common diagnostic procedure in hematology. Bleeding is an expected complication, and its risk is assumed to be increased in patients on anticoagulants. However, the effect of anticoagulation on BM biopsy safety is unclear and guidelines are lacking robust data in this regard. As such, physicians use their clinical judgement to guide periprocedural management of anticoagulation. objective: To provide the best available evidence regarding management of anticoagulation in patients who need BM biopsy. Methods: We reviewed and summarized available guidelines directing management of periprocedural anticoagulation for BM biopsy, and share our experience and practices with BM biopsy at our institution. Results: The incidence of significant hemorrhage after BM biopsy is very low (0.007-1.1%). BM biopsy is classified as having a low to moderate bleeding risk. Interrupting anticoagulation is not consistently recommended. Strategies exist to minimize bleeding risk for anticoagulated patients. Patients with myeloproliferative neoplasms can develop an acquired von Willebrand syndrome which increases their risk for bleeding and therefore require extra vigilance to ensure appropriate hemostasis. Conclusion: Withholding anticoagulation prior to BM biopsy is not routinely recommended. Instead, assessment and optimization of bleeding risk factors should be done on a patient by patient basis.

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Retroperitoneal Hematoma after Bone Marrow Biopsy: The First Cut Should Not Be the Deepest

Cited by 6 publications

References 25 publications

Blast-Derived Small Extracellular Vesicles in the Plasma of Patients with Acute Myeloid Leukemia Predict Responses to Chemotherapy

Blast-Derived Small Extracellular Vesicles in the Plasma of Patients with Acute Myeloid Leukemia Predict Responses to Chemotherapy

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

Anticoagulation and bone marrow biopsy: is it safe to proceed?

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