A nurse is assisting in planning care for a client who has advanced multiple myeloma. When planning care the nurse should recognize that the client is at risk for which of the following complications?

A. Hip: While “hip” can sometimes colloquially refer to the iliac crest, it is not commonly used to describe the specific site for aspiration outside of the iliac crest.

B. Cervical spine: The cervical spine is not a site used for bone marrow aspiration due to its inaccessibility and proximity to critical structures.

C. Sternum: The sternum is a common site for bone marrow aspiration in adults as it provides direct access to the marrow.

D. Humerus: The humerus is generally not used for bone marrow aspirations as it does not provide as accessible or large an area for aspiration.

Reported pain

• Leukemia: Possible, as bone pain can occur due to marrow involvement.
• Sickle Cell Anemia: Yes, common due to vaso-occlusive crises.
• Hemophilia: No, hemophilia typically causes bleeding rather than pain from blood cell abnormalities.

Bleeding

• Leukemia: Yes, due to thrombocytopenia.
• Sickle Cell Anemia: No, bleeding is not typical in sickle cell crises.
• Hemophilia: Yes, hemophilia is a bleeding disorder due to a clotting factor deficiency.

Temperature

• Leukemia: Yes, fever can indicate infection due to immunosuppression.
• Sickle Cell Anemia: Yes, fever can be a sign of infection during crises.
• Hemophilia: No, hemophilia does not cause fever unless there is an infection.

Bruising

• Leukemia: Yes, thrombocytopenia can lead to easy bruising.
• Sickle Cell Anemia: No, bruising is not typical in sickle cell crises.
• Hemophilia: Yes, due to a clotting factor deficiency, easy bruising is common.

WBC count

• Leukemia: Yes, often elevated due to immature or abnormal white cells.
• Sickle Cell Anemia: No, WBC count is usually normal unless there is an infection.
• Hemophilia: No, WBC count is typically normal in hemophilia.