Bone marrow scanning is a nuclear study performed to assist in diagnosing pathological conditions of active bone marrow in the axial skeleton in adults and in the full length of extremities in infants, with a gradual retraction in children until 10 years of age. The marrow moves peripherally in the long bones as red blood cell (RBC) production requirements increase, and this distribution can be detected on the scan. The degree of bone marrow activity and bone marrow distribution revealed provides the clinical information related to pathological processes.²³ The abnormalities seen on the scan include focal defects, increased size of the liver and spleen, decrease in the central marrow, peripheral extension, and increased uptake outside of normal areas (extramedullary hematopoiesis). Depending on the suspected pathology, 99mTc administered as technetium Tc 99m sulfur colloid is used when imaging the entire body about 1 hour after injection, or 111In as indium In 111 chloride is used when imaging the entire body 48 hours after injection.

• Normal distribution of active marrow in the axial skeleton; no avascular necrosis, extrame-dullary hematopoiesis, bone marrow infarcts or hemolytic anemia, metastatic bone tumor, or diffuse hematologic disorders

• Inability of client to remain still during the procedure

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Indications

• Diagnosing avascular necrosis in hip studies revealed by the absence or decrease of uptake activity
• Determining extramedullary hematopoiesis sites such as the liver, spleen, lymph nodes, lungs, kidneys, breasts, or adrenal glands
• Diagnosing thalassemia, sickle cell anemia, hereditary spherocytosis, and myeloproliferative disorders revealed by an increased uptake of radionuclide
• Diagnosing bone marrow infarcts common in sickle cell anemia and thalassemia revealed by "cold" areas with increased uptake in the surrounding active bone marrow
• Detecting metastases of malignant tumor to bone revealed by focal defects
• Diagnosing and determining the stage of diffuse hematologic disorders such as polycythemia vera, leukemia, hemolytic anemia, aplastic anemia, myelofibrosis, Hodgkin's and non-Hodgkin's lymphoma revealed by a decrease or absence of radionuclide uptake
• Evaluating a disparity between marrow histology and blood smear results to determine errors in marrow sampling
• Determining splenic erythrocytosis before splenectomy and determining whether enough active bone marrow is present to allow removal of the spleen²⁴
• Determining bone marrow depression during or after chemotherapy or radiation therapy

Contraindications

• Pregnancy, unless the benefits of performing the procedure greatly outweigh the risks to the fetus

[Section Outline]

• Indications
• Contraindications

Nursing Care Before the Procedure

Client teaching and physical preparation are the same as for any nuclear scan study (see section under "Brain Scanning").

• Inform the client of the scanning schedule and explain that the study takes 1 hour.
• Obtain a history to include information about known or suspected hematologic disorders and other associated tests and procedures performed.

The client is placed on the examining table in a supine position and reminded to remain very still during the scanning procedure. The radiopharmaceutical technetium Tc 99m sulfur colloid is injected IV, and imaging is begun after 30 minutes to 1 hour. Scanning of the entire body, both anteriorly and posteriorly, is performed. Technetium Tc 99m sulfur colloid is used to examine for avascular necrosis, bone marrow infarct and hemolytic anemias, metastatic tumors, and diffuse hematologic disorders. If indium In 111 chloride is injected, imaging is started in 48 hours, and scanning of the entire body is performed. This agent is used to examine the client for extramedullary hematopoiesis and sites of occurrence.

Nursing Care After the Procedure

Care and assessment after the procedure are the same as for any nuclear scan study (see section under "Brain Scanning").