Bone marrow biopsies: A hospitalist bedside procedure service 5-year experience.

BACKGROUND: Bone marrow aspiration and biopsies (BMAB) are a relatively frequent procedure needed in the inpatient setting, especially in a tertiary care center. OBJECTIVE: Procedure-focused hospitalists can provide an excellent option for doing inpatient BMAB. Here we present five years of experience with a hospitalist bedside procedure service (BPS) performing BMAB. DESIGN: In 2016, the BPS partnered with the oncology service to begin performing inpatient BMAB. SETTINGS AND PARTICIPANTS: We evaluated internally collected data from the procedures performed by the BPS from 2016-2020. INTERVENTION: From 2015-2016, faculty members on the BPS team were trained by the oncology department to do a BMAB, which was then offered as an inpatient procedure by the BPS from 2016-2021. MAIN OUTCOME AND MEASURES: Total number of BMAB performed, success rates, bleeding risk profiles of patients, rate of trainee participation, and complication rates. RESULTS: The BPS performed a total of 432 BMAB from 2016-2021. Forty-six (10.6%) were unsuccessful and required referral for CT guidance. Elevated bleeding risk was present in 88 (20.4%) of patients. Trainees assisted in 62 (14.4%) of the procedures.There was one complication (0.2%).

Cocaine and Levamisole Induced Vasculitis.

Levamisole adulterated cocaine is a rare cause of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis. It is increasingly diagnosed because of raised awareness; however, it is still underdiagnosed in part because of its rarity and patients not reporting cocaine use. Here we report a case of levamisole-induced vasculitis. We present a 48-year-old non-Hispanic white male with a past medical history significant for Crohn's Disease and pneumonia who presented with acute bilateral ear pain and rash. His urinary drug screen was positive, which prompted suspicion of contamination and potential levamisole adulterated cocaine-associated vasculitis. A punch biopsy showed evidence of leukocytoclastic vasculitis and multiple fibrin thrombi further supporting contamination with levamisole. We believe this case highlights the importance of using patient history in guiding diagnostic testing in the setting of acute vasculitis. Once the history of illicit substance use was confirmed, our differential diagnosis and considerations for treatment significantly changed.