How do you counsel patients on the risk of clinically relevant bleeding or other complications with bone marrow aspiration and biopsy?

I counsel patients that, in general, bone marrow biopsies are a fairly safe procedure from a bleeding standpoint due to minimal tissue between the skin and the bone, and the superficial nature of the biopsy, such that if there is bleeding, pressure can be applied.

That said, this depends on the ability to appropriately palpate landmarks and feel confident about the angle and target for the procedure. In a patient who is obese for whom I worry I may not be able to confidently assess landmarks, I ...

The risk of clinically relevant bleeding is very small. Some will get a local hematoma that can take a week or two to resolve. The only other significant complication I have seen over several hundred (thousands?) is when the biopsy needle broke, with a piece embedded in the iliac crest and needing to be surgically removed.

I request that my IR colleagues perform it when landmarks are difficult to palpate, and routinely if patient weight is over 300 lbs. At our institution, we do not offer consci...