Bone Marrow Biopsy

Introduction: Bone marrow is the spongy material found in the center of most large bones in the body. The different cells that make up blood are made in the bone marrow. Bone marrow produces red blood cells, white blood cells, and platelets. Along with a biopsy (the sampling of mostly solid tissue or bone), an aspiration (the sampling of mostly liquid) is often done at the same time.

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Doctors can diagnose many problems that cause anemia, some infections, and some kinds of leukemia or lymphoma cancers by examining a sample of your bone marrow (the tissue where blood cells are made). A bone marrow biopsy is the procedure to collect such a sample. It is done using a large needle inserted through the outside surface of a bone and into the middle of the bone, where the marrow is.

Why the procedure is performed: A bone marrow aspiration and biopsy procedure is done for many reasons.

*The test allows the doctor to evaluate your bone marrow function. It may aid in the diagnosis of low numbers of red blood cells (anemia), low numbers of white blood cells (leukopenia), or low numbers of platelets (thrombocytopenia), or a high number of these types of blood cells.

*The doctor can also determine the cause of some infections, diagnose tumors, determine how far a disease, such as lymphoma, has progressed, and evaluate the effectiveness of chemotherapy or other bone marrow active drugs.

*Where the procedure is performed: Bone marrow aspirations and biopsies can be performed in doctor’s offices, outpatient clinics, and hospitals. The procedure itself takes 10-20 minutes.

Preperation for the test:
You will need to sign a consent form giving your doctor permission to perform this test. Because you will probably receive some pain medicines or anti-anxiety medications that can make you drowsy, you will need to arrange a ride home.

Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Also talk with your doctor before the test if you are taking insulin, or if you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting. It may be necessary to stop or adjust the dose of these medicines before your test. Most people need to have a blood test done some time before the procedure to make sure they are not at high risk for bleeding complications.

*You may receive instructions about not eating food or drinking liquids before the procedure.

*Be sure to tell your doctor about any prescription medications, over-the-counter medications, as well as herbal supplements you are taking.

*Notify your doctor about all allergies, previous reactions to medications, if you have had any bleeding problems in the past, or if you are pregnant.

*Before the procedure, you will be asked to change into a patient gown.

*Your vital signs-blood pressure, heart rate, respiratory rate, and temperature-will be measured.

*Depending on your doctor, you may have an IV placed or your blood drawn.

*You may be given some medicine to help you relax.

*You may be asked to position yourself on your stomach or your side depending on the site the doctor chooses to use.

Risk Factors:
You will be asked to sign a consent form before the procedure. You will be notified of the alternatives as well as the potential risks and complications of this procedure.

Risks are minimal.

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Possible risks include these:

*Persistent bleeding and infection

*Pain after the procedure

*A reaction to the local anesthetic or sedative

Having a sample taken is not harmful for your bone or bone marrow. Injury of nearby tissue from the biopsy is very uncommon. You might have some buttock soreness for a few days, and you may have some bruising at the biopsy site. A few individuals have an allergy or a side effect from the pain medicine or anti-anxiety medicine.

What happens when the test is performed?
Most patients have this test done by a hematologist in a clinic procedure area. You wear a hospital gown during the procedure. A sedative may be injected at this time. (If you are prescribed a sedative in pill form, you will be instructed to take it ahead of time.)

*Most patients have bone marrow sampled from the pelvis. You lie on your stomach and the doctor feels the bones at the top of your buttock. An area on your buttock is cleaned with soap. A local anesthetic is injected to numb the skin and the tissue underneath the skin in the sampling area. This causes some very brief stinging.

*The doctor will choose a place to withdraw bone marrow. Often this is the hip (pelvic bone), but it also can be done from the breastbone (sternum), lower leg bone (tibia), or backbone (vertebra).

*The chosen site will be cleaned with a special soap (iodine solution) or alcohol. After the skin is clean, sterile towels will be placed around the area. It is important that you do not touch this area once it has become sterile.

*Local anesthetic, usually lidocaine, will be injected with a tiny needle at the site. Initially, there may be a little sting followed by a burning sensation. After a few minutes, the site will become numb. A needle is then placed through the skin and into the bone. You may feel a pressure sensation.

*For the bone marrow aspiration, a small amount of bone marrow is then pulled into a syringe.

*A bone marrow biopsy is then usually performed. A somewhat larger needle is then put in the same place and a small sample of bone and marrow is taken up into the needle.

*After taking the liquid sample, the doctor carefully moves the needle a little bit further into the bone marrow to collect a second sample of marrow called a core biopsy. This core biopsy is a small solid piece of bone marrow, with not just the liquid and cells but also the fat and bone fibers that hold them together. After the needle is pulled out, this solid sample can be pushed out of the needle with a wire so that it can be examined under a microscope. Pressure is applied to your buttock at the biopsy location for a few minutes, until you are not at risk of bleeding. A bandage is placed on your buttock.
Must you do anything special after the test is over?
You will feel sleepy from the medicines used to reduce pain and anxiety.
After the local anesthetic wears off over the next few hours, you may have some discomfort at the biopsy site. Your doctor will advise you about pain medication.Once these medicines have worn off (a few hours after the test), you can return to normal activities, but you should not drive or drink alcohol for the rest of the day.

You should keep the bandage on for 48 hours, and then it should be removed.

After the test:
The samples taken from your bone marrow will be sent to a laboratory and the pathologist for analysis. Several tests are done including looking at the bone marrow under a microscope. The results of these tests will usually be available in a few days. Your doctor will give you instructions for follow-up.

When to Seek Medical Care:
Call your doctor if you notice signs of spreading redness, continued bleeding, fever, worsening pain, or if you have other concerns after this procedure.

Go to a hospital’s emergency department if these conditions develop:

*If your bleeding will not stop with direct pressure
*If you see thick discharge from the wound
*If you have a persistent fever
*If you feel lightheaded

How long is it before the result of the test is known?
Some parts of your bone marrow biopsy report may be available within a day, but some tests require special stains or tests that can take longer, in some cases up to one week.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/bone-marrow-biopsy.shtml
http://www.emedicinehealth.com/bone_marrow_biopsy/article_em.htm

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