When the laboratory professional accompanies the clinician to assist with the bone marrow aspiration procedure to make smears at the bedside, it is necessary to understand the role of the clinician and the laboratory professional.
The clinician is responsible for patient positioning and sterile preparation, pain control, and performing the aspirate and biopsy. The clinician often hands-off sample syringes to the laboratory professional, once collected. The clinicians are responsible for providing the procedure kit and fixative for the biopsy, all labels, and obtaining the requisitions and a copy of the clinical history for the hematopathologist.
The laboratory professional will set up a mini workspace near the bedside where the samples are split into the required tubes. Smears are then prepared from the aspirate as well as biopsy touch preps before the biopsy is placed in fixative. In this setting, the laboratory professional will usually deliver the samples and requisitions to pathology and continue the processing procedure.
The kit the laboratory professional brings to the bedside usually contains mini Petri dishes, coverslips, slides, microcapillary tubes or Pasteur pipettes, micro-pipette bulbs, and the various evacuated blood collection tubes and media flasks required for the standard bone marrow draw.
Most institutions will have a standard draw and testing protocol designed to ensure that enough sample is obtained to cover all of the usual testing requirements. An example would be a three-syringe-draw with the first two syringes containing no anticoagulant and the third syringe rinsed with preservative-free heparin. The first dry pull would be split between a green top and a purple top tube and would be used for morphology (purple), flow cytometry (purple or green), and cytogenetics (green) if needed. The second dry pull is split into two additional purple top tubes and a green top tube and would be used for molecular assays, such as SNP array, Flt-3, JAK2, MPL, and more. The final heparinized syringe could be used for other treatment protocol requirements or to provide samples for additional assays.
