Bone Marrow Biopsy and Aspiration—What to Expect

Well, the more I have thought about my upcoming procedure, the more it has bothered me. Never mind that my father (who loves me very much, but is still learning about filters when it comes to this stuff) also called and pointed out the obvious to me:  this is not the same procedure I underwent the last time I was diagnosed. It appears I will be either partially or completely anesthetized, for one. This is alarming, as I neither received nor needed any sedation for my last bone marrow biopsy. So, I looked online to see what I could find out about the differences between “Bone Marrow Biopsy” and “Ultrasound Guided Bone Marrow Aspirate and Biopsy”. Follows is the best explanation I could find on what will be going on this Friday taken from Cancer.net . Of course, I still don’t know why I need to be sedated, or where the sample will be taken from, and this excerpt says absolutely nothing about “ultrasound guidance”. I just know that I am a little freaked.  There has been some friction between me and my father today, and I fully know and understand that it is simply because we are both scared and worried and exhausted from being scared and worried. I need to give that some thought and work on a healthy way to articulate my feelings, at least on this blog, so that I can try to keep things peaceful between us, since he is the biggest part of my support system and you know, also, we love each other and stuff.

Bone Marrow Biopsy and Aspiration—What to Expect

Bone marrow is the soft, spongy tissue that is found inside the center of bones. It produces red blood cells (cells that carry oxygen to all parts of the body), white blood cells (cells that help the body fight infections and diseases), and platelets (cells that help blood clot and help control bleeding). A bone marrow biopsy and aspiration is a diagnostic examination of the bone marrow that can provide information about the development and function of these cells.

A bone marrow biopsy and aspiration may be performed to diagnose the following conditions:

  • An infection with an unknown cause
  • Blood disorders
  • Chromosomal or genetic diseases
  • Cancer of the blood cells, such as leukemia
  • Lymphoma
  • Multiple myeloma

Besides diagnosis, this procedure is valuable for describing a blood cancer, identifying its subtype, classification, or stage. It is also used to monitor the side effects of chemotherapy and find out whether the treatment is working.

About the procedure

A bone marrow biopsy is a procedure that removes a small, solid piece of tissue for examination. A bone marrow aspiration removes a sample of the fluid, called an aspirate. A common site for a bone marrow biopsy and aspiration is the pelvic bone, which is located in the lower back by the hip.

A bone marrow biopsy and aspiration are usually done at the same time. Your doctor will determine whether you need a bone marrow biopsy, a bone marrow aspiration, or both.

The medical team

A bone marrow biopsy and aspiration is usually performed by an oncologist (a doctor who treats people with cancer), a hematologist (a doctor who treats people with blood diseases), or a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Other members of the health care team—such as a nurse or physician assistant—may be present during the examination. A pathologist will examine the bone marrow cells under a microscope, and the results will be summarized in a pathology report that will be given to your oncologist.

Questions to ask your doctor

Before you have a bone marrow biopsy and aspiration, consider asking your doctor the following questions:

  • Who will perform the bone marrow biopsy and aspiration?
  • What can I expect to happen during the procedure?
  • How long will the bone marrow biopsy and aspiration take?
  • What are the risks and benefits of having a bone marrow biopsy and aspiration?
  • Will I be awake or asleep during the procedure?
  • Will I feel any pain during the procedure? For how long? What can be done to reduce the pain?
  • How soon can I return to normal activities after the procedure?
  • Can you give me instructions on how to care for the wound?
  • When will I learn the results?
  • Who will explain the results to me? What further tests will be necessary if the results indicate cancer?

Preparing for the procedure

When you schedule your examination, you will get a detailed explanation of how to prepare for your bone marrow biopsy and aspiration. There are usually no restrictions on eating or drinking before the test, unless you are receiving general anesthesia. Your doctor will inform you of these restrictions when the test is scheduled.

You will be asked to review and sign a consent form that states you understand the risks and agree to have the test done. Talk with your doctor about any concerns you have about the bone marrow biopsy and aspiration.

During the procedure

A bone marrow examination takes about 30 minutes and is usually performed in an outpatient treatment area.

Because you will be receiving a local anesthetic (numbing medication), you will need to let your doctor know if you have ever had an allergic reaction to an anesthetic. A doctor may use conscious sedation (a type of anesthesia that uses pain relievers and sedatives so the patient is awake but does not feel any pain). Conscious sedation usually allows you to speak and respond during the procedure, but you may not have any memory of the procedure afterward.

If the pelvic bone is the site of the procedure, you will be asked to lie on your stomach on an examination table, and the skin surrounding the site will be cleansed with an antiseptic solution. A local anesthetic is injected into the skin and into the tissue next to the bone with a fine needle. At first, you will feel a slight stinging sensation before the area is numb.

If both a bone marrow biopsy and aspiration is needed, the bone marrow aspiration is completed first. A special, hollow needle is inserted into the numbed area and pushed gently into the bone. Once the needle is fully inserted, the center portion of the hollow needle is removed, a syringe is attached to the needle, and the liquid portion of the bone marrow is withdrawn into the syringe. You may feel a deep, dull, aching pain for a few seconds, similar to a toothache. It may help to hold a pillow tightly or squeeze another person’s hand. After the bone marrow aspirate is collected, the needle is removed, and the pain goes away.

For the bone marrow biopsy, a larger needle is inserted into the same area and guided into the bone. The needle is rotated until an adequate sample of tissue is removed. You may feel pain and pressure as the needle moves into the bone. The entire needle is then removed, and a pressure dressing (a protective covering that places pressure on top of a wound) is placed over the site to prevent bleeding. The medical team may ask you to lie down for about 20 minutes until the effects of the sedative wear off.

After the procedure

You will be able to go home shortly after the procedure. However, if you received sedation, you will need a ride home, so bring someone with you or make arrangements for a ride before the procedure. Otherwise, you can resume normal activities the same day.

Keep the area around the pressure dressing clean and dry. Ask your doctor when you can remove the dressing, and do not shower or bathe until that time. There will likely be some blood on the bandage, which is normal. You can then cover the wound with a bandage until it is fully healed. You may feel discomfort at the bone marrow biopsy and aspiration site for several days, especially when bending over. Mild bruising is normal and can occur several days after the procedure.

It is important to notify your doctor if you have any of the following problems after the bone marrow biopsy and aspiration:

  • Fever greater than 101 degrees Fahrenheit
  • Uncontrolled bleeding
  • Unusual discharge or severe pain at the examination site
  • Any other signs or symptoms of infection
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