What is a bone marrow biopsy. How is a bone marrow biopsy performed. Why might someone need a bone marrow biopsy. Is a bone marrow biopsy painful. How should one prepare for a bone marrow biopsy. What are the potential risks of a bone marrow biopsy. How long does it take to recover from a bone marrow biopsy.

Understanding Bone Marrow Biopsy: A Comprehensive Guide

A bone marrow biopsy is a medical procedure that involves extracting a small sample of bone marrow tissue for examination. This diagnostic test provides valuable insights into various blood disorders and helps healthcare professionals make informed decisions about treatment. But what exactly does this procedure entail, and why is it necessary?

What is Bone Marrow?

Bone marrow is the soft, spongy tissue found inside most bones. It plays a crucial role in the production of blood cells, including red blood cells, white blood cells, and platelets. By examining bone marrow, doctors can identify abnormalities in blood cell production and detect various blood-related conditions.

The Bone Marrow Biopsy Procedure: Step-by-Step

The bone marrow biopsy procedure is typically performed in a medical office or hospital setting. Here’s a breakdown of what you can expect:

1. Preparation: The patient is positioned comfortably, usually lying on their side or stomach.
2. Anesthesia: Local anesthetic is administered to numb the area where the biopsy will be performed.
3. Incision: A small incision is made in the skin to access the bone.
4. Biopsy: A specialized needle is inserted into the bone to extract a small sample of marrow.
5. Sample collection: The marrow sample is collected and prepared for laboratory analysis.
6. Wound care: The incision site is cleaned and bandaged.

The entire procedure typically takes about 20-30 minutes to complete.

Bone Marrow Aspiration vs. Biopsy

It’s important to note the distinction between bone marrow aspiration and biopsy. While both procedures involve collecting samples from the bone marrow, they serve different purposes:

• Bone marrow aspiration: This procedure removes a small amount of liquid bone marrow for examination.
• Bone marrow biopsy: This procedure extracts a small core of solid bone marrow tissue for analysis.

Often, both procedures are performed during the same appointment to provide a comprehensive evaluation of the bone marrow.

Common Sites for Bone Marrow Biopsy

Where is a bone marrow biopsy typically performed? The most common sites for bone marrow biopsy include:

• Posterior iliac crest (back of the hip bone)
• Anterior iliac crest (front of the hip bone)
• Sternum (breastbone) – usually only for aspiration in adults

The choice of site depends on factors such as the patient’s age, body composition, and the specific information needed from the biopsy.

Preparing for a Bone Marrow Biopsy

Proper preparation can help ensure a smooth and successful bone marrow biopsy procedure. Here are some important steps to take:

• Inform your doctor about any medications you’re taking, including blood thinners.
• Disclose any allergies, especially to medications or anesthetics.
• Mention any bleeding disorders or tendency to bleed easily.
• If you’re pregnant or suspect you might be, inform your healthcare provider.
• Arrange for someone to drive you home after the procedure, as you may feel drowsy.

Following these preparatory steps can help minimize risks and ensure a more comfortable experience.

The Pain Factor: What to Expect During a Bone Marrow Biopsy

One of the most common concerns patients have about bone marrow biopsy is the level of discomfort involved. While experiences can vary, here’s what you can generally expect:

• Initial sting: You’ll feel a sharp sting when the local anesthetic is injected.
• Pressure sensation: As the biopsy needle is inserted, you may feel pressure or a dull ache.
• Brief, sharp pain: During marrow aspiration, you might experience a quick, sharp pain.
• Post-procedure soreness: The biopsy site may feel sore for a few days after the procedure.

While some discomfort is normal, your healthcare provider will work to ensure you’re as comfortable as possible throughout the procedure.

Pain Management Strategies

To minimize discomfort during and after the bone marrow biopsy, several pain management strategies may be employed:

• Local anesthesia to numb the biopsy site
• Conscious sedation for anxious patients
• Over-the-counter pain relievers for post-procedure soreness
• Application of cold packs to reduce swelling and discomfort

Discussing your concerns about pain with your healthcare provider can help ensure appropriate pain management measures are in place.

Reasons for Performing a Bone Marrow Biopsy

Why might a healthcare provider recommend a bone marrow biopsy? This procedure is typically ordered when abnormalities are detected in blood tests or when certain conditions are suspected. Common reasons include:

• Diagnosing blood disorders such as leukemia, lymphoma, or multiple myeloma
• Evaluating unexplained anemia, thrombocytopenia, or other blood cell abnormalities
• Assessing the progression of blood cancers
• Monitoring response to cancer treatments
• Investigating persistent fevers of unknown origin
• Evaluating iron stores in the body

By providing a detailed look at the bone marrow, this procedure can offer crucial information for diagnosis and treatment planning.

Interpreting Bone Marrow Biopsy Results

After the bone marrow biopsy, the collected sample is sent to a laboratory for analysis. But what exactly do the experts look for, and how are the results interpreted?

Cellular Composition Analysis

Pathologists examine the bone marrow sample under a microscope to assess:

• The number and types of blood cells present
• The ratio of immature to mature cells
• Any abnormal cell shapes or sizes
• The presence of cancer cells or other abnormal cells

Genetic Testing

In some cases, additional tests may be performed on the bone marrow sample, including:

• Cytogenetic analysis to detect chromosomal abnormalities
• Flow cytometry to identify specific types of blood cells
• Molecular testing to look for genetic mutations associated with certain diseases

These advanced tests can provide valuable information for diagnosing specific conditions and guiding treatment decisions.

Turnaround Time for Results

The time it takes to receive bone marrow biopsy results can vary depending on the complexity of the analysis required. Generally, preliminary results may be available within a few days, while more detailed genetic testing can take several weeks.

Potential Risks and Complications of Bone Marrow Biopsy

While bone marrow biopsy is generally considered a safe procedure, it’s important to be aware of potential risks and complications. These may include:

• Bleeding or bruising at the biopsy site
• Infection, though this is rare with proper sterile technique
• Prolonged pain or discomfort
• Damage to surrounding tissues (uncommon)
• Allergic reaction to anesthesia (rare)

Your healthcare provider will discuss these risks with you and take appropriate precautions to minimize them.

When to Seek Medical Attention

After a bone marrow biopsy, it’s important to monitor for any signs of complications. Seek medical attention if you experience:

• Fever or chills, which could indicate infection
• Excessive bleeding or swelling at the biopsy site
• Severe or worsening pain that isn’t relieved by prescribed medications
• Numbness or weakness in the area near the biopsy site

Prompt attention to these symptoms can help prevent more serious complications.

Recovery and Aftercare Following a Bone Marrow Biopsy

The recovery process after a bone marrow biopsy is typically straightforward, but proper aftercare is essential for a smooth healing process. Here’s what you can expect:

Immediate Post-Procedure Care

• Rest at the medical facility for 30-60 minutes after the procedure
• Keep the biopsy site dry and covered for 24 hours
• Avoid strenuous activities for 24-48 hours
• Take pain relievers as recommended by your healthcare provider

Long-Term Recovery

Most patients can return to normal activities within a day or two after the procedure. However, it’s important to:

• Keep the biopsy site clean and dry
• Avoid soaking in water (baths, swimming pools) for a few days
• Monitor the site for signs of infection or excessive bleeding
• Attend follow-up appointments as scheduled

Full healing of the biopsy site typically occurs within 1-2 weeks.

Advances in Bone Marrow Biopsy Techniques

As medical technology continues to evolve, so do the techniques used for bone marrow biopsy. Recent advancements aim to improve patient comfort and diagnostic accuracy:

Image-Guided Biopsies

The use of imaging technologies such as CT scans or ultrasound can help guide the biopsy needle more precisely, potentially reducing discomfort and improving sample quality.

Powered Biopsy Devices

New powered devices can obtain bone marrow samples more quickly and with less manual force, potentially reducing patient discomfort and improving the consistency of samples.

Liquid Biopsies

While not a direct replacement for traditional bone marrow biopsies, liquid biopsies (which analyze tumor DNA circulating in the blood) are being explored as a less invasive alternative for monitoring certain blood cancers.

These advancements hold promise for making bone marrow biopsies more comfortable and effective in the future.

The Role of Bone Marrow Biopsy in Cancer Diagnosis and Treatment

Bone marrow biopsy plays a crucial role in the diagnosis and management of various blood cancers and disorders. Here’s how this procedure contributes to cancer care:

Initial Diagnosis

For suspected blood cancers such as leukemia, lymphoma, or multiple myeloma, a bone marrow biopsy can:

• Confirm the presence of cancer cells in the bone marrow
• Identify the specific type and subtype of cancer
• Determine the extent of bone marrow involvement

Staging and Prognosis

Once a diagnosis is made, bone marrow biopsy results can help:

• Determine the stage of the cancer
• Assess the aggressiveness of the disease
• Provide information about potential prognosis

Treatment Planning and Monitoring

Throughout the course of cancer treatment, repeat bone marrow biopsies may be performed to:

• Guide treatment decisions based on the cancer’s characteristics
• Monitor response to therapy
• Detect minimal residual disease after treatment
• Assess for potential relapse

By providing detailed information about the bone marrow environment, these biopsies help oncologists tailor treatment plans and make informed decisions about patient care.

Bone Marrow Biopsy in Pediatric Patients

While the basic procedure for bone marrow biopsy is similar in children and adults, there are some important considerations for pediatric patients:

Site Selection

In infants and young children, the tibia (shin bone) may be used as a biopsy site instead of the hip bone, as it’s easier to access in small patients.

Pain Management

Pediatric patients may require additional measures for pain control and anxiety reduction, such as:

• Sedation or general anesthesia, especially for very young children
• Child life specialists to provide emotional support and distraction techniques
• Parental presence for comfort, when appropriate

Post-Procedure Care

Special attention is given to ensuring children understand the importance of keeping the biopsy site clean and avoiding strenuous activities during recovery.

By tailoring the approach to the needs of pediatric patients, healthcare providers can help make the bone marrow biopsy experience as comfortable and stress-free as possible for young patients and their families.

Bone marrow biopsy Information | Mount Sinai

Biopsy – bone marrow

A bone marrow biopsy is the removal of marrow from inside bone. Bone marrow is the soft tissue inside bones that helps form blood cells. It is found in the hollow part of most bones.

Bone marrow biopsy is not the same as bone marrow aspiration. An aspiration removes a small amount of marrow in liquid form for examination.

A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

A bone biopsy is performed by making a small incision into the skin. A biopsy needle retrieves a sample of bone and it is sent for examination. The most common reasons for bone lesion biopsy are to distinguish between benign and malignant bone tumors, and to identify other bone abnormalities. Bone biopsy may also be performed to determine the cause of bone pain and tenderness.

How the Test is Performed

A bone marrow biopsy may be done in the health care provider’s office or in a hospital. The sample may be taken from the pelvic or breast bone. Sometimes, another area is used.

Marrow is removed in the following steps:

• If needed, you are given medicine to help you relax.
• The provider cleans the skin and injects numbing medicine into the area and surface of the bone.
• A biopsy needle is inserted into the bone. The center of the needle is removed and the hollowed needle is moved deeper into the bone. This captures a tiny sample, or core, of bone marrow within the needle.
• The sample and needle are removed.
• Pressure and then a bandage are applied to the skin.

A bone marrow aspiration may also be done, usually before the biopsy is taken. After the skin is numbed, the needle is inserted into the bone, and a syringe is used to withdraw the liquid bone marrow. If this is done, the needle will be removed and repositioned. Or, another needle may be used for the biopsy.

How to Prepare for the Test

Tell the provider:

• If you are allergic to any medicines
• What medicines you are taking
• If you have bleeding problems
• If you are pregnant

How the Test will Feel

You will feel a sharp sting when the numbing medicine is injected. The biopsy needle may also cause a brief, usually dull, pain. Since the inside of the bone cannot be numbed, this test may cause some discomfort.

If a bone marrow aspiration is also done, you may feel a brief, sharp pain as the bone marrow liquid is removed.

Why the Test is Performed

Your provider may order this test if you have abnormal types or numbers of red or white blood cells or platelets on a complete blood count (CBC).

This test is used to diagnose:

• Anemia (some types)
• Infections
• Leukemia
• Other blood cancers and disorders

It may also be used to help determine if a cancer has spread or responded to treatment.

Normal Results

A normal result means the bone marrow contains the proper number and types of blood-forming (hematopoietic) cells, fat cells, and connective tissues.

What Abnormal Results Mean

Abnormal results may be due to cancers of the bone marrow (leukemia, lymphoma, multiple myeloma, or other cancers).

The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).

Specific conditions for which the test may be performed:

• A body-wide fungal infection (for example, disseminated coccidioidomycosis)
• A white blood cell cancer called hairy cell leukemia
• Cancer of the lymph tissue (Hodgkin or non-Hodgkin lymphoma)
• Bone marrow doesn’t make enough blood cells (aplastic anemia)
• Blood cancer called multiple myeloma
• Group of disorders in which not enough healthy blood cells are made (myelodysplastic syndrome; MDS)
• A nerve tissue tumor called neuroblastoma
• Bone marrow disease that leads to an abnormal increase in blood cells (polycythemia vera)
• Abnormal protein buildup in tissues and organs (amyloidosis)
• Bone marrow disorder in which the marrow is replaced by fibrous scar tissue (myelofibrosis)
• Bone marrow produces too many platelets (thrombocythemia)
• White blood cell cancer called Waldenström macroglobulinemia
• Unexplained anemia, thrombocytopenia (low platelet count) or leukopenia (low WBC count)

Risks

There may be some bleeding at the puncture site. More serious risks, such as serious bleeding or infection, are very rare.

Bates I, Burthem J. Bone marrow biopsy. In: Bain BJ, Bates I, Laffan MA, eds. Dacie and Lewis Practical Haematology. 12th ed. Philadelphia, PA: Elsevier; 2017:chap 7.

Chernecky CC, Berger BJ. Bone marrow aspiration analysis-specimen (biopsy, bone marrow iron stain, iron stain, bone marrow). In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:241-244.

Choby BA. Bone marrow aspiration and biopsy. In: Fowler GC, ed. Pfenninger and Fowler’s Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 220.

Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 31.

Last reviewed on: 4/29/2022

Reviewed by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

This Is Going to Hurt: Revisiting the Patient Experience of Bone Marrow Biopsies

Hemasphere. 2022 Apr; 6(4): e710.

Published online 2022 Mar 25. doi: 10.1097/HS9.0000000000000710

¹

Author information Copyright and License information Disclaimer

I am starting to feel a pattern is emerging, of acceding to a request on the basis of partial information and then not being able to pull out when the beans are fully spilled

-Claire Gilbert, writing about her bone marrow biopsy during myeloma diagnosis in her collection of letters “Miles to go before I sleep”¹

Bone marrow aspirate and trephine (BMAT) is a common procedure for the diagnosis and response assessment of many hematological conditions. As a hematology registrar, I commonly consent patients for BMAT, perform the procedure, and hear patients’ reflections on their experience. I have listened to senior colleagues set expectations for the procedure—“it will just take five minutes”; “it is safe and generally well-tolerated”; or “it can be a little uncomfortable but it’s over quickly”—expectations that often do not reflect my observations of patients’ experiences. One conversation stands out: a patient in his 30s in remission from acute myeloid leukemia who required intensive chemotherapy, reinduction with chemotherapy postrelapse, and an allogeneic stem cell transplant. He told me that of the entirety of his healthcare experiences, his diagnostic bone marrow biopsy was the worst of them all. He had subsequently required a further 14 bone marrow procedures for response assessment or surveillance.

How common is pain in bone marrow procedures? Relatively few studies have sought to answer this question. A Swiss group prospectively surveyed 700 adult bone marrow procedures at a single centre, with patients reporting “bearable pain” in 59. 6% and “unbearable pain” in 3.7% of cases.² Another prospective study surveyed immediate and postprocedural pain in 235 hemato-oncology adult patients at a Swedish centre. A total of 70% of patients reported pain: of these, 56% was moderate, 32% severe, and 3% the worst possible. Pain was present in 42% of patients at 3 days post-procedure, and 12% after 1 week.³ There is inadequate evidence of pain incidence beyond this timeframe. However, one provocative study of patients reviewed in the pain clinic at the MD Anderson Cancer Center demonstrated a significant incidence of sacro-iliac joint (SIJ) pain in 4.95% of patients who had undergone bone marrow biopsy during the 1-year study period. The median time from BMAT to SIJ pain of 3.5 weeks in this study is beyond what would be usual for immediate post-procedure pain.⁴

It is worth noting that some of the most widely cited literature on BMAT morbidity (a series of UK surveys led by Professor Bain) was based on reporting from clinicians rather than patients. These surveys reported five incidents of persistent pain across 2 years of data collection with a denominator of 39,852 procedures (0.01% incidence).^5,6 This could reflect a very low incidence of persistent pain, or more likely reflects clinicians’ lack of enquiry about severe or persistent pain, or a perception that it is not noteworthy enough to report. Underestimation of pain in BMAT is common: one study reported that both doctors and nurses recognized pain to be severe in only one-third of cases where patients self-reported severe pain during BMAT.⁷

Pain is not distributed equally. Younger patients and those with higher body mass index experience more pain during BMAT.⁸ Patients who have experienced severe pain in previous BMAT experience more pain in subsequent procedures.² The observation that unemployed patients experience higher levels of pain hints at the impact of social factors and power dynamics.³

Given that pain is reported by most patients during BMAT, why do clinicians commonly use euphemisms like “uncomfortable” or “mostly well-tolerated,” rather than directly acknowledging the likelihood of pain, which can be severe or persistent? There are likely to be several reasons. The first is amnesia: senior clinicians who set patients’ initial expectations of the BMAT may not have performed or even witnessed one for many years and may genuinely not know or remember how painful they are. Alternatively, clinicians may underemphasize pain with the aim to minimize a patients’ anxiety pre-procedure: while this may help patients who encounter minimal pain, others may be shocked by their experience and could lose confidence in the trustworthiness of their clinicians. We may be motivated by fear that the patient will refuse a crucial BMAT which is in their best interests, if we emphasize the painfulness of the procedure. Finally, there is likely to be a subconscious element of “not wanting to be the bad guy”: during a positive and affirming encounter with a patient, we do not want to be tarnished by the prospect of causing them pain.

Can anything be done to reduce the pain experienced during and after BMAT procedures? Pediatric practitioners make use of pre-medications, deep sedation/general anesthesia, and modalities such as art therapy to help develop coping techniques through. In contrast, for adults undergoing BMAT in institutions I have worked with, pain relief is limited to local anesthesia, and if a patient is anxious, they may be offered a low dose oral benzodiazepine. The difference in practice is partly explained by the inverse correlation of pain and age, and partly from the increase of complications from sedation with increasing age, but also reflects different service provision limitations and clinician attitudes towards pain in adult and pediatric settings.

We can do better: many studies have demonstrated the value of pharmacological and non-pharmacological approaches to reduce pain in BMAT in adults. Three examples of effective interventions are music, buffered lidocaine, and tramadol. Music can reduce pain and anxiety experienced during BMAT^9,10 and can be easily offered to all patients. Buffering lidocaine with bicarbonate reduces pain during instillation of the anesthetic^11,12 and in one study reduced the overall pain experienced throughout the BMAT procedure. ¹² A 50 mg dose of tramadol given 1 hour prior to procedure reduced the incidence of moderate or severe pain to 20% compared to 40% in patients receiving placebo, with no toxicities from tramadol seen. Tramadol has been shown to be safe and effective in reducing pain in other procedural settings such as dressing changes in burns patients¹³ and during hysteroscopy.¹⁴ In contrast, the effectiveness of inhalational nitrous oxide has not been consistently shown, although may still be helpful in some patient groups.^15,16

There is surprisingly little research into how to train practitioners who perform BMAT. There is no published research in how to train doctors for BMAT, and only one published guideline for training and assessing the competency of nurse practitioners in carrying out the procedure.¹⁷ It is informed by educational theory and provides a structure to procedural training, which improves upon the “see one, do one, teach one” approach and could be used for training doctors and other staff. Further work is needed on the effectiveness of simulation-based training,¹⁸ and on the best approaches clinicians can take to patient education and communication.

In summary, we need to aspire towards “well-tolerated” and “slightly uncomfortable” BMATs by the deployment of pharmacological and non-pharmacological analgesic methods, and by better methods of practitioner training. For the time being, we need to be honest about the likelihood and potential severity of procedural pain and allow patients to take this into account when deciding whether to go ahead with the procedure.

1. Claire G. Miles To Go Before I Sleep. London: Hodder & Stoughton; 2021. [Google Scholar]

2. Degen C, Christen S, Rovo A, et al.. Bone marrow examination: a prospective survey on factors associated with pain.
Ann Hematol. 2010;89:619–624. [PubMed] [Google Scholar]

3. Lidén Y, Landgren O, Arnér S, et al.. Procedure-related pain among adult patients with hematologic malignancies.
Acta Anaesthesiol Scand. 2009;53:354–363. [PMC free article] [PubMed] [Google Scholar]

4. Roldan CJ, Huh BK, Chai T, et al.. Sacroiliac joint pain following iliac-bone marrow aspiration and biopsy: a cohort study.
Pain Manag. 2019;9:251–258. [PMC free article] [PubMed] [Google Scholar]

5. Bain BJ. Bone marrow biopsy morbidity: review of 2003.
J Clin Pathol. 2005;58:406–408. [PMC free article] [PubMed] [Google Scholar]

6. Bain BJ. Morbidity associated with bone marrow aspiration and trephine biopsy – a review of UK data for 2004.
Haematologica. 2006;91:1293–1294. [PubMed] [Google Scholar]

7. Lidén Y, Olofsson N, Landgren O, et al.. Pain and anxiety during bone marrow aspiration/biopsy: comparison of ratings among patients versus health-care professionals.
Eur J Oncol Nurs. 2012;16:323–329. [PMC free article] [PubMed] [Google Scholar]

8. Valebjørg T, Spahic B, Bremtun F, et al.. Pain and bleeding associated with trephine biopsy.
Eur J Haematol. 2014;93:267–272. [PubMed] [Google Scholar]

9. Schandert LC, Affronti ML, Prince MS, et al.. Music intervention: nonpharmacologic method to reduce pain and anxiety in adult patients undergoing bone marrow procedures.
Clin J Oncol Nurs. 2021;25:314–320. [PubMed] [Google Scholar]

10. Shabanloei R, Golchin M, Esfahani A, et al.. Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration.
AORN J. 2010;91:746–751. [PubMed] [Google Scholar]

11. Kuivalainen AM, Ebeling F, Rosenberg P. Warmed and buffered lidocaine for pain relief during bone marrow aspiration and biopsy. A randomized and controlled trial.
Scand J Pain. 2014;5:43–47. [PubMed] [Google Scholar]

12. Ruegg TA, Curran CR, Lamb T. Use of buffered lidocaine in bone marrow biopsies: a randomized, controlled trial.
Oncol Nurs Forum. 2009;36:52–60. [PubMed] [Google Scholar]

13. Zhang XH, Gao XX, Wu WW, et al.. Impact of orally administered tramadol combined with self-selected music on adult outpatients with burns undergoing dressing change: a randomized controlled trial.
Burns. 2020;46:850–859. [PubMed] [Google Scholar]

14. Samy A, Nabil H, Abdelhakim AM, et al.. Pain management during diagnostic office hysteroscopy in postmenopausal women: a randomized study.
Climacteric. 2020;23:397–403. [PubMed] [Google Scholar]

15. Kuivalainen AM, Ebeling F, Poikonen E, et al.. Nitrous oxide analgesia for bone marrow aspiration and biopsy – A randomized, controlled and patient blinded study.
Scand J Pain. 2015;7:28–34. [PubMed] [Google Scholar]

16. Johnson H, Burke D, Plews C, et al.. Improving the patient’s experience of a bone marrow biopsy – an RCT.
J Clin Nurs. 2008;17:717–725. [PubMed] [Google Scholar]

17. Jackson K, Guinigundo A, Waterhouse D. Bone marrow aspiration and biopsy: a guideline for procedural training and competency assessment.
J Adv Pract Oncol. 2012;3:260–265. [PMC free article] [PubMed] [Google Scholar]

18. Yap ES, Koh PL, Ng CH, et al.. A bone marrow aspirate and trephine simulator.
Simul Healthc. 2015;10:245–248. [PubMed] [Google Scholar]

Biopsy and bone marrow aspiration

Azarova Ksenia Olegovna

Reproductologist

Clinic “Mother and Child” Yaroslavl

How the examination is performed

Puncture (aspiration) of the bone marrow in patients is usually done from the posterior iliac crest of the pelvis, while the patient lies on his stomach. The procedure area is disinfected. The puncture is performed with a special puncture needle. For the study, disposable imported needles are used.

In a bone marrow biopsy, a sample of the hard part is taken with a larger needle. Usually, with a bone marrow biopsy, it is done simultaneously with aspiration.

When puncturing the posterior iliac crest of the pelvis, local anesthesia is performed with novocaine or lidocaine, as well as with trephine biopsy. If you are allergic to these medicines, be sure to tell your doctor before starting the procedure!

Do not confuse a bone marrow puncture from the ilium with a spinal puncture of the spinal canal, in which cerebrospinal fluid is taken for analysis. They are completely different procedures!

Preparation for examination

Bone marrow sampling is often performed on an outpatient basis and usually does not require special preparation. Taking bone marrow is often painless and the procedure requires little time: biopsy usually takes about 20 minutes, aspiration – 5-10 minutes.

Before the procedure

For most people, local anesthesia is all that is needed for a comfortable examination. It is possible to conduct research under anesthesia.

After the procedure

After taking the bone marrow, a sterile bandage is applied to this area. You can then go home and return to your daily activities.

Wound care

The bandage in the area of ​​bone marrow sampling must remain dry for 24 hours.

Bone marrow analysis

Bone marrow analysis (myelogram count and trephine biopsy assessment) is carried out by a laboratory diagnostics doctor and a pathomorphologist who issues an appropriate conclusion.

The conclusion of the bone marrow analysis is necessary for your hematologist or oncologist to make the correct diagnosis.

The test results are prepared within a few days. Check with your doctor when you can get them. In some cases, multiple analyzes may need to be performed over time.

Risks and complications during examination

Complications of bone marrow aspiration or biopsy are rare, but some patients may experience bleeding from the bone marrow site.

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to the doctor – Azarova Ksenia Olegovna

Clinic “Mother and Child” Yaroslavl

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Biopsy: does it hurt?

Biopsy: does it hurt?

When faced with a doctor’s referral for a biopsy, many patients wonder if it hurts. But the doctors immediately give their answer – modern medical equipment, which you can buy from us, new methods for taking a biopath and the experience of doctors will allow us to talk about its painlessness. Especially if high-quality medical equipment is used, in particular, the MAX-CORE automatic disposable biopsy instrument.

Types of punctures and their implementation

.

If we talk about whether it is painful to undergo a biopsy, it all depends on the characteristics of the body, the level of the pain threshold and the type of the most prescribed manipulation.

1. Bone marrow examination – biopath sampling is carried out using a special Kassirsky needle. Most often, such biopsy sampling is carried out on the sternum or calcaneus, one of the bones of the small pelvis
2. From the cavity of the peritoneum, the fluid of the walls themselves is taken, and if gynecological pathologies are suspected, the fluid is taken from the retrouterine space or through the posterior fornix of the vagina

Carrying out a puncture – it all depends on its type, taking into account the organ being examined.

• If a pleural puncture is prescribed, doctors use local anesthesia. The patient is seated with his back to the doctor, and the injection site itself is treated with a local anesthetic. Previously, the doctor conducts an ultrasound scan and determines the exact location of the focus of the pathological process, thereby simplifying and facilitating the biopath sampling. If there is a need to pump out excess liquid, a special container is attached to the needle and it is collected there
• If bone marrow sampling is performed, surgery is also performed using a local type of anesthesia. The patient is laid on his back, the needle insertion site is treated with a special composition and the needle is inserted – the Kassirsky needle by scrolling it. So it is introduced into the middle of the sternum and then the spinal cord is pumped out into the cavity of the syringe
• If the biopath is taken from the peritoneal cavity, the instrument is inserted through the wall of the abdominal cavity, and in case of gynecological diseases, the anus of the vagina or the anus.