# A 53-year-old patient with suspected leukemia is scheduled for a bone marrow biopsy this morning to confirm the diagnosis. Which assessment finding would be the most important for the nurse to report to the healthcare provider before the procedure?

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> subject: Adult Health

## 문제

A 53-year-old patient with suspected leukemia is scheduled for a bone marrow biopsy this morning to confirm the diagnosis. Which assessment finding would be the most important for the nurse to report to the healthcare provider before the procedure?

## 보기

1. Patient reports anxiety about the procedure and asks multiple questions
2. Patient's hemoglobin level is 8.5 g/dL (normal: 12-16 g/dL for women)
3. Patient's platelet count is low (thrombocytopenia) **✔ 정답**
4. Patient has not been NPO (nothing by mouth) for the past 8 hours

**정답: 3**

## 해설

Low platelet count (45,000/mm³) indicates severe thrombocytopenia, which poses a high bleeding risk during invasive procedures like bone marrow biopsy. Other findings (anxiety, low hemoglobin, non-NPO status) are less critical for immediate safety.

## 심화 해설

Critical Safety Rationale for Pre-Procedure Assessment

Before an invasive procedure such as a bone marrow biopsy, the nurse's primary responsibility is to identify and report findings that increase the risk of a life-threatening complication. While a bone marrow biopsy is considered a minimally invasive procedure with a low overall complication rate [1], the most significant immediate risk is hemorrhage, particularly in a patient with a suspected hematologic malignancy like leukemia, where normal bone marrow function is already compromised.

Why Thrombocytopenia is the Priority Finding

A low platelet count, or thrombocytopenia, directly impairs primary hemostasis. Platelets are essential for forming the initial plug at the site of vascular injury. During a bone marrow biopsy, the needle penetrates the periosteum and the bone marrow cavity, both of which are highly vascular structures. In a patient with an inadequate number of functional platelets, this controlled trauma can lead to prolonged, uncontrolled bleeding from the biopsy site. This can result in a significant hematoma, ongoing blood loss, and hemodynamic instability. The risk is amplified in leukemia patients because thrombocytopenia is often severe and may be accompanied by platelet dysfunction. Reporting this finding allows the provider to take preemptive measures, such as transfusing platelets immediately prior to the procedure to temporarily correct the hemostatic defect and mitigate bleeding risk.

Analysis of Other Options

- Option 1 (Anxiety and questions): While addressing a patient's anxiety is an important nursing intervention, it is an expected response and does not pose a direct physiologic threat to the patient's safety during the procedure. Education and emotional support can be provided by the nurse without delaying the biopsy.

- Option 2 (Hemoglobin of 8.5 g/dL): This finding indicates moderate anemia, which is a common consequence of leukemia. While it requires monitoring and eventual treatment, it does not create an immediate risk of a procedural complication. The body can compensate for chronic anemia, and a biopsy does not typically cause enough blood loss to acutely worsen this condition to a critical level.

- Option 4 (Not NPO for 8 hours): A bone marrow biopsy is typically performed under local anesthesia with or without conscious sedation. Strict NPO status is not a standard requirement for the procedure itself, unlike surgeries requiring general anesthesia. Therefore, this is not a finding that must be reported to cancel or delay the case.References (research sources)

- [1]Bone Biopsies: Practical Considerations and Technical Tips.Research articleWilliams AE, Ho JW, Sundaram N. (2024) · DOI: 10.1055/s-0044-1791720

## 임상 시나리오

Pre-Bone Marrow Biopsy Safety CheckPrioritizing Hemorrhage Risk Assessment
The most critical pre-procedure assessment is identifying thrombocytopenia, as a low platelet count directly impairs primary hemostasis and dramatically increases the risk of uncontrolled hemorrhage from the highly vascular bone marrow biopsy site.

A platelet count below 50,000/µL is a common threshold for considering a pre-procedure platelet transfusion to temporarily correct the hemostatic defect.

CautionDo not confuse this with anemia or anxiety. While important, a low hemoglobin level does not cause immediate procedural bleeding, and NPO status is not required for a standard bone marrow biopsy performed under local anesthesia.

## 핵심 개념

- **Thrombocytopenia** — A condition characterized by abnormally low levels of platelets in the blood, impairing primary hemostasis and increasing the risk of bleeding.
- **Bone Marrow Biopsy** — An invasive procedure to obtain a core of bone marrow, usually from the posterior iliac crest, for diagnostic evaluation of hematologic conditions.
- **Hemostasis** — The physiological process of stopping bleeding at the site of an injury, involving platelet aggregation and coagulation cascade activation.
- **Retroperitoneal Hemorrhage** — Bleeding into the retroperitoneal space, a potential life-threatening complication of a posterior iliac crest bone marrow biopsy if hemostasis is impaired.

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