Bone Marrow Collection Plan Prevents Avoidable Redraws

Neil Osterweil

October 06, 2015

NASHVILLE, Tennessee — It is hard to satisfy pathologists, technologists, physicians, and patients at the same time, but a standardized bone marrow collection protocol appears to do just that.

The protocol is intended to reduce clinical delays and prevent the redraws that can occur when the first draw does not provide an adequate sample for special testing situations.

In developing the protocol, "we were attempting to ensure that the clinicians performing the procedure and the technologists attending the procedure were clear on what tubes were needed, given the clinical indication for the procedure," Lauren Pearson, DO, a third-year pathology resident from the University of Vermont Medical Center in Burlington, told Medscape Medical News.

Dr Pearson reported an analysis of specimens collected in accordance with the protocol here at the College of American Pathologists 2015 Meeting. During a 6-month period, they collected specimens from 151 patients.

The protocol mandates that when an order for bone marrow collection is placed, clinical history be included, along with the reason for the test.

Planning Ahead for Successful Collection

For a standard, uncomplicated exam or diagnostic procedure, clinicians and technologists are asked to collect three tubes, Dr Pearson explained — a sterile EDTA tube, a tube for cytogenetics, and a tube for flow cytometry.

But for patients with suspected acute myeloid leukemia or suspected pancytopenia, which could indicate an undetected leukemia, pathologists might want to perform molecular testing, so two EDTA tubes are added. And for patients with suspected plasma cell dyscrasias, pathologists might want to perform a myeloma fluorescent in situ hybridization (FISH) panel, which requires an extra plasma cell enrichment step, so a sodium heparin tube is added.

"We've been successful, with the specimen being collected according to the protocol 89% of the time," she reported. "In the very few cases where we were missing one or more tubes, we were still able to complete all the testing in almost 70% of those cases."

The primary barriers to the successful collection of all required samples were patient-related factors, such as a dry tap due to myelofibrosis or difficult aspirate.

In response to an anonymous survey, technologists reported that they found the procedure easier to follow than the old protocol, that it improved collection of the correct samples, and that it improved relationships on the patient floor.

The technologists love this. They feel that their communication with the clinicians has been enhanced.

"The technologists love this. They feel that their communication with the clinicians has been enhanced," Dr Pearson said. "Likewise, the clinicians love it because they know what to expect, what kinds of tubes they will need. We were very encouraged that the clarity of the protocol is good, and that, overall, the people doing the work on the floors and working directly with the patient feel that it has enhanced patient care."

Although few patients are likely to be happy about having to undergo bone marrow draws, reducing the need for additional draws certainly can't hurt, she pointed out.

This protocol is valuable because it points the way to improving patient care, said Diane Davey, MD, from the University of Central Florida in Orlando.

"I'm all about improving patient care so that we don't have to have repeat testing and can get everything we need the first time," she told Medscape Medical News. This protocol provides "a good, systematic approach to specimen collection for better patient care."

The study was internally funded. The study authors and Dr Davey have disclosed no relevant financial relationships.

College of American Pathologists (CAP) 2015 Meeting: Poster 209. Presented October 5, 2015.


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