Chemotherapy - Having a Bone Marrow Biopsy

Introduction

Your doctor has advised you that you need to have a sample of your bone marrow taken. This is called a bone marrow biopsy. Bone marrow is a spongy material that fills the bones and produces the cells which develop into blood cells.

The aim of this leaflet is to help you understand what happens when you have this test.

If you think that you may be late, you cannot attend or you need to change your appointment, please let us know by contacting the Haematology Secretary 0161 778 5297.

Before you come

You do not need to do anything special to prepare for this test. You can eat and drink as normal. You do not need to bring anything with you for the test itself. As with any test you may be feeling anxious, so you are welcome to bring someone with you. You will be given a local anaesthetic before the biopsy. This means that you can drive after the test, although you may feel sore and may prefer to arrange for someone to drive you home. Otherwise, you can continue with normal activities before and after the test.

It is important to let us know if you are taking any anti- coagulants (blood thinners), such as aspirin, clopidogrel, warfarin, clexane and apixaban. If you are unsure, then please contact us before the procedure as you may need to stop taking this.

Remember to bring change for parking machines and any drinks or snacks you wish to purchase. Light refreshments will be provided following your procedure.

How long will it take?

The actual test takes less than 30 minutes. It is difficult to say how long you will be at the hospital because this will depend on other things, such as how you are feeling, if you have other tests and how busy the department is at the time. We can only apologise if there seem to be delays. We will do our best to keep to appointment times and let you know what is happening.

Are there any risks?

As with most procedures there is a small risk of complications which may include bleeding and bruising at the site of the procedure and pain at the site of the procedure. Adverse events have been reported in 0.08% of procedures in a review of over 20,000 bone marrow biopsies.

The sample is taken from the back of your pelvic bone (at the back of the hip), so there is no risk of damaging any major organs. (Very rarely we may need to take a sample from another site. If so, this will be discussed with you). There may be some bleeding, but a dressing usually stops this. If you are taking any medication to thin the blood, please let the doctor or nurse who is doing the test know before you have the biopsy. You may also notice some bruising, but again this is normal and will fade.

There is a very small risk of infection at the site of the biopsy. This affects less than 1 person in 1000 who has this test.

What are the benefits of the test?

This is a very safe and quick test that can help us find out exactly what is wrong and plan the best treatment for you.

Is there an alternative to a bone marrow biopsy?

No. This test is often essential to diagnose or rule out a problem with your bone marrow. Many patients who have a blood problem will need to have a bone marrow test at some time. This may be to help with the diagnosis or to see how the disease is responding to treatment. Of course, if you decide that you do not want this test then we will be more than happy to discuss this with you.

What happens first?

The doctor or nurse will fully explain the procedure to you and there will be time for you to ask any questions. We want to involve you in decisions about your care and treatment. If you decide to go ahead you will be asked to sign a consent form to say that you agree to have the test and understand what it involves.

The test is conducted by a doctor or a nurse with special training. It takes about 15 minutes, and no special preparation is needed.

The doctor or nurse usually takes the bone marrow sample from the back of the hip bone. You will be given an injection of local anaesthetic to numb the area. We have ‘gas and air’ (Entonox) available; this will help you relax and to manage any pain, it will not put you to sleep.

How is the sample obtained?

The doctor or nurse will ask you to lie on your side. The area where the sample is taken will be cleaned with an antiseptic before you are given an injection of local anaesthetic to numb the area.

You will feel a sharp stinging for a few seconds when you have this injection. More local anaesthetic is injected to surround the bone where the sample is taken.

Once the anaesthetic has started to work, another needle is passed into your bone marrow. You will feel the doctor or nurse pushing and you may feel the needle ‘give’, which may cause you to jump – this is normal. In most cases, no more than a few drops of liquid are withdrawn, although sometimes more is required for additional tests. Some people feel a stinging sensation and have some discomfort or pain, but this lasts only for a few seconds. The doctor or nurse usually takes a further sample of the bone using the same needle entry site as before – if needed, more anaesthetic can be used. This takes a little longer than the first needle and once again can be painful but lasts only a few seconds.

A small dressing will be applied which can be removed later in the day or the next day.

Following the test, you may want to rest for a short time. Once the test is over you should not have any difficulty returning to your normal activities.

Does the test hurt?

This test is not completely pain free. The local anaesthetic injection will numb the area that surrounds the bone but cannot numb the bone itself. Although you may have some pain, this is for a very short time.

When you return home if you have any worries or concerns, please do not hesitate to contact us.

You may have aching for a few days in the area where the sample is taken. You can take mild painkillers such as paracetamol tablets to relieve this. Remember to follow the instructions on the packet.

When will I know the results?

Early results can take a day or two – further results are available within 10 days. If special tests are necessary, the full results may take some weeks. We will contact you to arrange an appointment to let you know the results as soon as they are available. Very rarely the test may need to be repeated if the samples obtained are inadequate, this would be discussed with you when you attend your outpatient clinic appointment.

We know that waiting for your results can be a worrying time.

Please do not hesitate to ask any questions or discuss any concerns you may have. We are happy to advise you.

For advice and information, please contact:

Haematology Secretary 0161 778 5297