Bone Marrow Aspiration and Trephine Bone Marrow Biopsy
Patient Information
Introduction Your doctor has recommended this test to you as the best way to find out important information about your illness and its treatment. This booklet explains what is involved before, during and after the operation. It does not replace the discussion between you and your doctor but helps you understand more about what is discussed. What is a bone marrow aspiration and trephine bone marrow biopsy? The bone marrow is the spongy tissue and fluid, which is found inside the bones in the body. It makes your red and white blood cells and the platelets from cells called 'stem cells'. In some of the larger bones in the body, such as the pelvis and chest bone, the bone marrow can be accessed and a sample removed. • A bone marrow aspiration removes some of this bone marrow fluid which is then usually looked at under the microscope or tested in other ways. • A trephine bone marrow biopsy removes a small sample of bone marrow tissue. The sample of tissue is then examined under the microscope to look for abnormal cells and may also be tested in other ways. Who has a bone marrow aspiration and trephine bone marrow biopsy? There are a number of reasons why you may be advised to have these tests and this will have been explained to you by your doctor. These can include: • To find the cause of low blood counts. • To determine the presence or development of a disease. • To monitor treatment responses. Your doctor may have recommended that you only have an aspiration, or you may need to have an aspiration and biopsy together. Your doctor will discuss this with you further. What preparation is needed before the test? • If you are taking aspirin or warfarin, please speak to your doctor as soon as possible before the procedure for further advice. Ideally this should be discussed at the time the procedure is booked. Your doctor will decide if you need to stop warfarin or aspirin in advance of the procedure and if you need a blood test before the bone marrow test to check how well your blood will clot. 1
• Tell your doctor or nurse if you have previously had an allergic reaction to any local anaesthetics. • You may be given the opportunity to have a sedative before the procedure, which will make you sleepy throughout. • If a sedative is given then you will be asked not to eat and drink for several hours before the procedure. If you do not have a sedative then you can continue to eat and drink as normal. You will need to sign a consent form before the procedure to say that you understand what it involves. How are these tests done? Bone marrow samples are usually taken from the top of the pelvis bone, also known as the hip. This is the bony area that you can easily feel just below your waist. You will usually be asked to lie on a bed on your left side in a comfortable position with your knees raised. The skin will be cleaned with antiseptic and a local anaesthetic is then injected into the area over the chosen site. The anaesthetic stings a little at first, but then makes the skin numb. Bone marrow aspiration In case you need to have both an aspiration and biopsy, the aspiration will be done first. A needle will be passed through the skin and into the hip bone. A small amount of liquid bone marrow will be withdrawn into a syringe. At this point you may feel some discomfort for a few seconds, although many patients do not feel any pain at all. The sample will then be taken off for testing in the laboratory. Trephine bone marrow biopsy If a trephine bone marrow biopsy is being taken, then this is done immediately after the aspiration. In some cases a second needle will be inserted into the same site after removal of the aspiration needle. Alternatively the first needle may be left in place and used to take the trephine biopsy. The needle will be passed a few centimetres into the bone and rotated through one or two turns to obtain the sample. You may feel pushing and a slight discomfort at this point. The needle will be removed and the sample taken for testing. After the needle is removed a dressing will be put on the site. After the test • If you have had sedation you must not drive home or travel on your own. Please bring someone with you who can take you home. If this is a problem for you discuss it with your nurse before you come into hospital. 2
• You will need to lie on a bed for up to two hours to ensure that no excessive bleeding occurs. • You may have some discomfort and bruising over the test site for a few days which you can ease with normal painkillers such as paracetamol. • If you have had a sedative you will continue to feel drowsy for several hours so please do not operate machinery, drive or sign any legal papers for 24 hours. • You should not soak the area where the biopsy has been taken for 48 hours after you return home. This means that you must avoid going swimming or having a bath for this time. You may have a shower during this time. • When you return home you will have a dressing in place. This can be removed after 24 hours. What are the risks of trephine bone marrow biopsy and aspiration? Complications are uncommon. In a small number of cases, there is some bleeding from the biopsy site. This is usually minor and soon stops. Occasionally, the bleeding is more severe and rarely a blood transfusion may be necessary. There is a small risk that the wound will become infected after the biopsy. If the pain worsens or the site becomes sore or inflamed contact a member of the medical team who will advise you. Rarely, the biopsy needle damages other nearby structures. What are the alternatives? Your doctor has recommended this test to you as the best way to find out important information about your illness and how to treat it. If you choose not to have the procedure it could delay you receiving important treatment. If you have any questions your doctor will discuss these with you. What happens next? Before you leave an appointment will be made for you to come back to the hospital and discuss the results further.
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Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: 0121 424 2280 Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: 0121 424 9486 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: 0121 507 3792 Fax: 0121 507 3816 University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: 0121 697 8417 Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: 0800 783 9050 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. 4
