Using intraosseous (intramedullary) blood samples for pre-transfusion and other testing

A blood bank section chief at a Missouri hospital reports that a question has come up at her hospital about intraosseous (intramedullary) blood sample collections. They wonder if blood samples can be collected for pre-transfusion testing when intraosseous IVs have been started. They also wonder about other testing (chemistry tests, hemoglobin, etc).

In response to the above query, a physician who is extremely knowledgeable in clinical laboratory testing comments that several questions would arise if pediatricians obtained specimens from patients undergoing intramedullary fluid infusions.

1. How much of a void volume should be obtained to consider the specimen representative (undiluted)?
   
   
2. Was the specimen derived from marrow venous sinuses or marrow matrix (equivalent of edema fluid)?
   
   
3. If the specimen comes from the marrow matrix, would it be contaminated by the infusion since there is no mixing or venous flow?
   
   
4. Most importantly, we do not have reference ranges for bone marrow chemistries.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator