[57].exostoses [58.59].increased bone-seeking isotope uptake [60].or false positive PETscans in the region of the biopsy procedure [6]. Other-Seldom,patients may experience persistent discomfort at the site of biopsy [48].Exceedingly rare cor plications have included transient neuropathy h glute compan ent syndr me se yto ost-biopsy bleeding [62].fracture due to underlying osteoporosis [48],and/or osteomyelitis [2]. Sternal aspiration -Complications of stemal aspiration are rare,but meri special consideration due to their potential seriousness.The sternum is only one centimeter thick in the adult,which may predispose to through-and- through penetration of the stemum with potentially fatal cardiovascular complications pe eumothorax pulmonary emboli. infection,and he ero cture [63] aspiration should not be undertaken in young children due to the risk of perforating the stemal plate.For the same reasons,marrow biopsy at sternal sites is contraindicated. SUMMARY AND RECOMMENDATIONS Indications and contraindications The following medical settings constitute the major indications for bone marrow aspiration and/or biopsy.(See 'Indications'above.) .Evaluation of unexplained anemia.leukopenia.thrombocytopenia.or pancytopenia Diagnosis and staging of lymphomaor .Evaluation of elevated perpheral blood counts (eg.polycythemia. thrombocytosis,leukocytosis) .Diagnosis and evaluation of plasma cell disorders and leukemias .Evaluation of iron metabolism and iron stores .Evaluation of suspe cted d osition and sto orage diseases(eg amyloidosis,Gaucherdisease .Evaluation of fever of undetermined ongin.suspected mycobacterial fungal,or parasitic infections,or granulomatous diseases Unexplained splenomeaaly Evaluation of suspected chr omosomal disorders in neonates .Confirmati on th tthe bone marrow is normal in a potential allogeneic hematopoietic cell dono Bone marrow aspiration and/or biopsy is contraindicated patients with severe hemophilia,severe disseminated intravascular coagulation,or other related[57], exostoses [58,59], increased bone-seeking isotope uptake [60], or false￾positive PET scans in the region of the biopsy procedure [61]. Other — Seldom, patients may experience persistent discomfort at the site of biopsy [48]. Exceedingly rare complications have included transient neuropathy with gluteal compartment syndrome secondary to post-biopsy bleeding [62], fracture due to underlying osteoporosis [48], and/or osteomyelitis [2]. Sternal aspiration — Complications of sternal aspiration are rare, but merit special consideration due to their potential seriousness. The sternum is only one centimeter thick in the adult, which may predispose to through-and￾through penetration of the sternum with potentially fatal cardiovascular complications, pericardial tamponade, pneumothorax, pulmonary emboli, infection, and bone erosion, thinning, or sternal fracture [63]. Sternal aspiration should not be undertaken in young children due to the risk of perforating the sternal plate. For the same reasons, marrow biopsy at sternal sites is contraindicated. SUMMARY AND RECOMMENDATIONS Indications and contraindications The following medical settings constitute the major indications for bone marrow aspiration and/or biopsy. (See 'Indications' above.) ●Evaluation of unexplained anemia, leukopenia, thrombocytopenia, or pancytopenia ●Diagnosis and staging of lymphoma or solid tumors ●Evaluation of elevated peripheral blood counts (eg, polycythemia, thrombocytosis, leukocytosis) ●Diagnosis and evaluation of plasma cell disorders and leukemias ●Evaluation of iron metabolism and iron stores ●Evaluation of suspected deposition and storage diseases (eg, amyloidosis, Gaucher disease) ●Evaluation of fever of undetermined origin, suspected mycobacterial, fungal, or parasitic infections, or granulomatous diseases ●Unexplained splenomegaly ●Evaluation of suspected chromosomal disorders in neonates ●Confirmation that the bone marrow is normal in a potential allogeneic hematopoietic cell donor Bone marrow aspiration and/or biopsy is contraindicated patients with severe hemophilia, severe disseminated intravascular coagulation, or other related