Sternal puncture

Sternal puncture, also known as a sternum bone marrow biopsy or sternal tap, is a medical procedure used to obtain a sample of bone marrow for diagnostic examination. This procedure is particularly valuable in the diagnosis and management of various hematologic diseases, including leukemia, anemia, and bone marrow disorders. The sternum (breastbone) is chosen for puncture due to its accessibility and the relative ease with which a sample can be obtained from the marrow cavity.

Procedure

During a sternal puncture, the patient is typically in a supine (lying face up) position. Local anesthesia is administered to minimize discomfort. A specialized needle is then carefully inserted through the skin and into the sternum to reach the bone marrow. A syringe is used to aspirate (draw out) a small sample of the marrow. The procedure is performed with strict aseptic techniques to prevent infection.

Indications

Sternal puncture is indicated for the evaluation of various hematologic conditions when peripheral blood tests and other diagnostic measures do not provide sufficient information. It is particularly useful for:

• Diagnosing and staging of hematologic malignancies such as leukemia
• Evaluating unexplained anemias
• Investigating febrile neutropenia
• Assessing bone marrow cellularity and architecture

Risks and Complications

While generally safe, sternal puncture carries risks and potential complications, including:

• Pain and discomfort at the puncture site
• Infection
• Hemorrhage
• Injury to underlying structures
• Rarely, pneumothorax (collapsed lung) if the needle is inserted too deeply

Alternatives

An alternative to sternal puncture is the iliac crest bone marrow biopsy, where bone marrow is sampled from the iliac crest of the pelvis. This site is often preferred for its larger marrow cavity, which can provide a more substantial sample for examination.

Aftercare

Following the procedure, pressure is applied to the puncture site to prevent bleeding. The patient is monitored for any immediate complications. Pain relief and wound care instructions are provided as needed.

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