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You have been referred by your doctor to see a Haematologist, a doctor who specialises in problems with the blood. During the appointment the haematologist may consider it necessary to perform a bone marrow biopsy in order to investigate your medical condition further. This may be performed at the time of your appointment or a further appointment will be made you to have the biopsy performed a few weeks later.
What is Bone Marrow?
The bone marrow is the soft, spongy tissue in the centre of bones, which produces blood cells.
What is a bone marrow biopsy?
There are two types of bone marrow biopsy and both are performed under a local anaesthetic. They can be performed as a single or combined test at the same time.
1) Bone marrow aspirate:
This involves inserting a needle into your hip bone (very occasionally your breast bone) to obtain a small sample of the bone marrow so that it can be examined under a microscope.
2) Trephine bone marrow biopsy:
This involves the collection of a small core of bone from the hip bone, along with the marrow inside.
This biopsy allows the doctor to look at the bone marrow in more detail and to perform a number of different tests. It may be necessary to perform only a bone marrow aspirate, but occasionally both types of biopsy need to be performed. The type of biopsy to be performed will be discussed with you before the procedure is performed.
Who will perform the bone marrow biopsy?
The biopsy is performed by a haematology doctor in the Macmillan Unit.
Do I need to do anything before coming for my appointment?
If you are taking any medications please bring these with you to the appointment so the doctor can check these during your consultation. If you are taking any medication to thin your blood or prevent blood clots (anticoagulants) such as aspirin, warfarin or heparin, you should inform the doctor or telephone the Macmillan Unit for advice, as these medications will need to be stopped two days before the bone marrow biopsy. The doctor will advise you when to restart the medication after the procedure, usually within a few hours. Please tell the doctor if you have any allergies or are sensitive to anything.
What happens when I come to the Clinic?
You will be asked to come to the Macmillan Unit to see one of the Haematology doctors. The doctor will talk to you about your medical problem and may examine you and take some blood tests.
If it is necessary for you to have a Bone Marrow Biopsy the doctor will discuss this with you and explain why they think you should have the test done. The doctor who will perform the biopsy will explain the procedure, including potential risks and you will have an opportunity to ask questions and if you are happy to proceed with the procedure you will be asked to read and sign a Consent Form.
A nurse will accompany you to the treatment room and help you to get onto the bed and into the correct position. To make the procedure easier it is necessary for you to lie flat on your side with your knees curled up. If lying on either side, flat or curling your legs up is difficult or uncomfortable please speak to your nurse/doctor and they will help you to get into a comfortable position with the use of pillows or adapt the way the procedure is performed to the position that you are able to lie in.
The doctor will examine your hip bone to find the correct place for the biopsy. The skin will be cleaned to prevent any infection and allowed to dry. A local anaesthetic will be injected into the surface of the skin where the biopsy needle will be positioned to take the bone marrow sample. The local anaesthetic sometimes has a warm stinging sensation at first, but the area begins to go numb within a few moments. Further anaesthetic is then injected a little deeper and then against the surface of the hip bone where the biopsy needle will be positioned to take the sample.
Initially, this area can be a little sensitive but will go numb. The doctor will wait for the anaesthetic to take full effect and will test that the area is comfortable / numb before proceeding. The aspirate biopsy needle is inserted through the skin until it rests against the correct position on the hip bone. The needle is then gently worked through the outer layer of the bone into the spongy inner space to take the sample. This sample resembles blood and is put onto slides ready to go to the lab. The inner part of the bone has no nerve endings but due to the small vacuum created when sucking the sample out, patients sometimes get a brief twinge which stops after a few seconds.
If you only need a bone marrow aspirate then the biopsy is complete and the needle will be removed and a sterile dressing applied, which can be removed after 48 hours. If the doctor thinks that it is necessary for you to also have a bone marrow trephine this will be discussed with you and performed immediately after the bone marrow aspirate. A bone marrow trephine is carried out almost identically to the bone marrow aspiration, but this test is performed to take a small core sample of the bone marrow approximately 1cm in length.
This may take a few minutes longer than the bone marrow aspirate and some patients find this procedure a little uncomfortable. If you find this part of the test uncomfortable then tell the doctor or nurse and they can rest for a few minutes before completing the test. It is possible to have an inhaled pain relieving gas, such as that used by women during labour. If you feel that this is necessary or would like to have this “on hand” then discuss this with your nurse before the test begins.
Can I take pain relieving tablets?
Occasionally people feel a little bruised after the anaesthetic has worn off. You may wish to take a mild pain killer, please ask the doctor or nurse for advice. After the test has been performed the nurse will escort you to the treatment area, make you a drink and advise you how long you need to stay in the Macmillan Unit before going home. It is often a good idea to bring someone along for support and to drive you home.
When will I get the results of my Bone marrow test?
Before you leave the unit the nurse will make an appointment for you to see the doctor to discuss the results of the biopsy. It can take up to three weeks for all the tests to be preformed, so your appointment will usually be 3-4 weeks following the biopsy. During this period we may arrange for you to have other tests/scans so that we have all the information we need before you see the doctor again. The nurses and doctors work with other healthcare professionals looking after you, including your GP or District Nurse, to ensure you receive the best advice and treatment.
You will continue to be seen at regular intervals by your Consultant, and you will still remain under their care. The nurses at the clinic will keep your Consultant updated on progress with your care.
What if I have a problem?
If you have any problems or concerns during your visit to the Macmillan Unit, please speak to the nurse looking after you. The nurse will try to help you or arrange for you to see a doctor or your own GP for further assessment and advice. The nurse will give you details of who to contact if you have a problem in between appointments.
What if I have further questions?
If you have any questions or concerns, or do not understand something you can contact the Macmillan Unit on: 01908 996351, 9am–5pm Monday to Friday.
If you have a problem outside of these hours you should follow the advice given to you after your bone marrow biopsy or contact your GP/ out of hours service. You may find it useful to use the space below to jot down any questions you might want to ask when you come for your clinic appointment.