Safety of CT-Guided Bone Marrow Biopsy in Thrombocytopenic Patients: A Retrospective Review

Abstract

Purpose: To test the hypothesis that computed tomography (CT)-guided bone marrow biopsy in patients with a platelet count between 20,000/uL and 50,000/uL is safe and that preprocedure platelet transfusion is unnecessary.

Materials and methods: This single-center retrospective study included bone marrow biopsies performed between May 2009 and May 2016. The study population included 981 patients-age range, 15-93 years; average age, 57 years; 505 (51.5%) men; and 476 (48.5%) women. One hundred eighty-seven biopsies were performed in patients with a platelet count of 20,000-50,000/μL; 33 were performed in patients with a platelet count of < 20,000/μL. The primary endpoint was hemorrhagic complications, Society of Interventional Radiology (SIR) complication class C or above. The complication rates in thrombocytopenic patients were compared to patients with a platelet count of ≥ 50,000/uL. Ninety-five percent confidence intervals (CIs) for the complication rate in each group were also calculated.

Results: There were no SIR class C or above postprocedure bleeding-related complications, including interventions or transfusions. For patients with a platelet count of < 20,000/μL and of 20,000-50,000/μL, hemorrhagic complications rates were 0% (95% CI: 0-9.1%) and 0% (95% CI: 0-1.6%), respectively.

Conclusions: CT-guided bone marrow biopsy is safe in thrombocytopenic patients, with a hemorrhagic complication rate below 1.6% for patients with a platelet count of 20,000-50,000/μL. Routine preprocedure platelet transfusion may not be necessary for patients with a platelet count of 20,000-50,000/μL.