ARRS 2022 Abstracts

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1236. Thrombocytopenia and Risk of Complications Computed Tomography vs Fluoroscopic Guided Posterior Iliac Crest Bone Marrow Aspirate and Biopsy
Authors * Denotes Presenting Author
  1. Keith Kuo *; Spencer Fox Eccles School of Medicine
  2. Jacob Williamson; Spencer Fox Eccles School of Medicine
  3. Claire Kaufman; University of Utah School of Medicine
Objective:
The posterior iliac crest (PIC) is a common location for image guided bone marrow aspiration and biopsy (BMAB) procedures. Data are limited on hematologic lab value usage as predictors of complications. Due to the indications and underlying disease processes, many patients receiving BMAB procedures present with thrombocytopenia, abnormal coagulation parameters, or pancytopenia. The purpose of this study is to evaluate if uncorrected thrombocytopenia, elevated international normalized ratio (INR), or other abnormal hematologic parameters leads to increased complications in BMAB when using imaging guidance, computed tomography (CT) or fluoroscopic.

Materials and Methods:
After IRB approval, a single institution retrospective review was performed in compliance with the Health Insurance Portability and Accountability Act (HIPAA) guidelines of all images guided from 2014-2021. A total of 402 CT or fluoroscopic-guided BMABs from the PIC were included in the study (296 CT and 106 fluoroscopy BMABs). The patients were subdivided based on their platelet count; < 20 platelets x 109/L, 20-50 platelets x 109/L, and > 50 x 109/L. The electronic medical record and PACS were reviewed for age, sex, specimen adequacy, pathologic diagnosis, body mass index (BMI), pre-procedure labs including platelet count, hemoglobin, hematocrit, INR, white blood count, procedure time, type of sedation, and complications. Statistical analysis was performed using a Fischer exact test, Cochrane-Mantel-Haenszel, and logistic regression model to examine the association between different variables and complications.

Results:
A total of 136 patients (125 women, 111 men) received 402 PIC BMABs. Mean age was 56.6 years (95% CI 55.2–55.8) and BMI was 30.9 (95% CI 30.0 - 31.8), respectively. Of the 402 BMAB diagnoses there were 311 plasma cell disorders and leukemias, 34 anemia, leukopenia, thrombocytopenia, or pancytopenia, 26 lymphomas, 22 elevated peripheral blood counts, three metastatic cancer, three mycobacterial or granulomatous disease, one amyloidosis, and one iron deficiency anemia. The Fischer Exact test demonstrated no significant association between platelet count and risk of complications during the BMAB (p =1). The Cochrane-Mantel-Haenszel test demonstrated no significant association between INR and the risk of complications during the BMAB (p = 0.984). The logistic regression model demonstrated no significant difference between CT or fluoroscopy-guided and complication occurrence during the BMAB while controlling for imaging modality and platelet count (p = 0.997).

Conclusion:
Image-guided BMAB procedures from the PIC yielded no significant risk of complications based on low platelet values or elevated INR. There was no difference in the complication rate with CT or fluoroscopic guidance. Our findings suggest that taking an image-guided BMAB from the PIC is safe with low risk of complications even in severely thrombocytopenic patients (platelet count <20 x 109/L). This is important as it can prevent unnecessary transfusions in this patient population.