Bone Marrow Biopsy (Information for Patients)

Why do I need this test?

The marrow is the site of normal production of blood cells – red cells, white cells and platelets. Blood cells may be lacking or abnormal in their development, produced in excess, or replaced by cells normally foreign to the marrow. Examination is sometimes required to assess initial involvement of the marrow by disease and thereafter the progress of treatment.

How is it performed?

Under local anaesthetic, a tiny incision is made in the skin at the back of the pelvis above the buttock. A narrow needle inserted into the thick bone beneath this area is used to obtain samples of marrow. Approximately one teaspoon of liquid marrow and a 2-3cm solid piece (core) of bone and bone marrow are taken.

What to expect?

The pathologist performing the biopsy will carefully describe what will happen and answer any questions you may have before commencing.

Although not essential, some patients or their doctors prefer a mild pre-medication for this procedure. This is only possible in the hospital setting. These drugs reduce anxiety or discomfort and some have a hypnotic effect (help you to forget the biopsy). You should discuss this with your own doctor before attending for the procedure.

You will need to sign a written consent prior to any intravenous medication.

The local anaesthetic stings briefly but insertion of the needle is painless. You will still sense pressure. Removal of the initial fluid takes about 3-4 seconds and may cause a deep ache or sharp discomfort in the buttocks or thighs which will subside immediately. Removal of the bone core may or may not ache a little, but takes less than one minute.

Once underway, the entire procedure lasts approximately 5-10 minutes, but you will need to lie flat and be observed for 30 minutes afterwards. The incision does not require a stitch, but a waterproof dressing applied to protect the site should be kept intact for three days.

Afterwards

Local pain or tenderness at the site of the biopsy is common when the local anaesthetic wears off, but will subside over 1-2 days. Paracetamol or codeine containing analgesics are permissible and preferred to aspirin. Bleeding is uncommon and can be managed with pressure applied to the site. Infection is rare, but please report any increasing pain, redness or discharge to your doctor. You will be given written instructions following the procedure. Results are available at the time of your scheduled review by your doctor.

Patient instructions

Please notify the doctor requesting the procedure, the nurse or the Melbourne Pathology collection staff booking the procedure, if you are taking warfarin, are diabetic, have an artificial joint or mechanical heart valve, have previously had radiotherapy to your pelvis or have recently had a PET scan. Specific instructions may be required for some patients.

If you are having pre-medication, you should fast from midnight (morning procedure), or fast after breakfast (afternoon procedure). You may drink clear fluids up to 2 hours prior to your arrival for the biopsy.

• Take your normal morning medications.
  
• Wear comfortable loose clothing that allows access to your hip area.
  
• Arrange for someone to drive you home. You cannot drive for 24 hours after intravenous pre-medication.
• Keep the dressing intact and dry for 3 days.
  
• Showering is acceptable but please do not bath, swim or use a spa for 48 hours.
  
• A mild analgesic such as paracetamol or codeine may be taken for local pain if required.
  
• If the biopsy site appears to bleed into the dressing at home (very uncommon), lie down for 30 minutes with a firmly rolled, small towel pressed beneath you onto the dressing.
  
• If the biopsy site becomes increasingly red, swollen, painful or develops a discharge after 48 hours, if may be infected (extremely uncommon). Contact your doctor for prompt review.

Any further enquiries should be directed to your treating doctor or contact our Haematologists on 9287 7700.