A bone marrow biopsy is often needed as part of the staging process for some lymphoma/CLL subtypes.
Who needs a bone marrow biopsy?
Lymphoma is mainly a disease that is mostly located in the lymphatic system or lymph nodes. Some lymphomas can be found in the bone marrow in advanced disease or common in certain subtypes such as chronic lymphocytic leukaemia (CLL).
A bone marrow biopsy is a test that tests to see whether lymphoma cells are located in the bone marrow. It is needed for some patients at diagnosis, prior to treatment, post treatment, to monitor the disease status and if relapse (comes back) is suspected. A bone marrow biopsy is not required for all patients. Your doctor will let you know if this is required for you.
What is a bone marrow biopsy?
The bone marrow is the spongy part in the middle of your bones. This is where blood cells are made. A bone marrow biopsy is a procedure where samples of bone marrow are taken so that they can be examined. A doctor or nurse takes the sample of bone marrow from your hip. Two different types of sample are usually taken:
- Bone marrow aspirate (BMA): this test takes a small amount of the liquid found in the bone marrow space
- Bone marrow aspirate trephine (BMAT): this test takes a small sample of the bone marrow tissue
These samples are sent to the laboratory where they are looked at under the microscope. The doctors are looking to see if any lymphoma cells are present. Other tests may also be done on your bone marrow samples.
What happens before the test?
You will be given detailed information about the procedure and how to prepare. The doctors will ask you to sign a consent form to say that you understand the procedure and that you allow them to perform it. You should make sure you fully understand it and ask any questions. You may need to have a blood test before the procedure to check that your blood clots normally.
You need to tell your doctor if you are taking any medicines, including vitamins or supplements. If you are taking anything that might thin your blood then it is possible you will need to stop this before the procedure.
In most cases, people only need a local anaesthetic to make the area numb. Some patients will be awake during the procedure but you have the option to have sedation (medicine to make you sleepy) to help you relax , if you feel anxious about pain, or if you have found a previous biopsy painful. Sedation is not recommended for everyone; you will need to discuss what is best for you with your doctor. Some types of medication that may be available include:
- Gas and air – Gas and air gives short-acting pain relief that you breathe in yourself when you need it.
- Intravenous medication – medication is given to make you sleepy but not completely asleep.
- Penthrox inhaler – is a medicine used to reduce pain. It is breathed in using a special inhaler. Patients usually recover afterwards faster from this type of sedation.
If you are not having sedation, you can eat and drink before the test. If you are having sedation, your medical team can advise you if you need to stop eating or drinking for a time before the test.
What happens during the test?
Bone marrow biopsies are usually taken from your pelvis (hip bone). You will be asked to lie on your side and curl up, with your knees pulled up toward your chest. On rare occasions the sample may be taken from your sternum (breastbone). If this is the case you would lie on your back. It is important to be comfortable and make sure you tell the staff if you are uncomfortable. The doctor or nurse will clean the area and inject the local anaesthetic into the area.
The bone marrow aspirate is done first. The doctor or nurse will insert a special needle through the bone and into the space in the middle. They will then withdraw a small amount of the bone marrow fluid. You may feel a brief sharp pain when the sample is being drawn. This takes just a few minutes. On very rare occasions a sample of the fluid can not be withdrawn. If this happens the doctor will need to take the needle out and try again in a different area.
The doctor or nurse will then take a sample of the harder bone marrow tissue. The needle is specially designed to take a small core of the bone marrow tissue, about as wide as a matchstick.
What happens after the test?
You will need to stay lying down for a short amount of time (around 30 minutes). The staff will check to make sure there is no bleeding. Most people who need a bone marrow biopsy have the procedure as an outpatient and do not have to stay in hospital overnight. If you have not had any intravenous sedation it is likely you can go home after the procedure. If you have had intravenous sedation you will need to stay in the hospital until the sedation has worn off and you are safely able to leave. You will need someone to take you home and you are not able to drive for 24 hours after the procedure. The staff at the hospital will give you more instructions on this.
The local anaesthetic will wear off and you may have some discomfort where the needle was inserted. You can take pain relief such as paracetamol, check with your medical team if you need anything stronger than this. If the pain continues or is very strong you should contact your nurse or doctor.
You will have a small dressing covering the site, keep this on for at least 24 hours. You can usually return to your usual activities once the pain has settled.
What are the risks?
A bone marrow biopsy is usually a very safe procedure. It is common to experience some pain during the procedure and afterwards. Check with your doctors about what pain relief you can take if you need to. You may have some bleeding at the site. It may start to bleed again when you go home. If this happens you should apply some pressure, if the bleeding does not stop once you have applied pressure then you will need to contact your doctor. In rare circumstances bleeding may be more serious.
Infection is a rare complication of the procedure. You must contact your doctors if you have any signs of infection such as;
- Fever (temperature above 38 degrees Celsius)
- Increased pain at the injection site
- Swelling or redness at the injection site
Occasionally the procedure is unsuccessful or the sample does not give a diagnosis, if this happens it may need to be repeated. Your medical team should give you more information about when to seek advice.