Aspiration and Biopsy: Bone Marrow





What It Is



Bone marrow aspirations and biopsies are performed to examine bone
marrow, the spongy liquid part of the bone where blood cells are made.

In a bone marrow aspiration, a small amount of liquid marrow is taken
from inside the bone so the cells can be examined under a microscope.

In a bone marrow biopsy, a small piece of intact bone marrow is
removed so the structure of the bone marrow inside its bony framework
can be examined. Occasionally, only an aspiration is needed; other
times, both tests are done.

The aspiration and biopsy are done by a trained medical practitioner
(nurse or doctor) using a small needle inserted into a bone. Usually the
back of the hipbone (iliac crest) is used.

Why It's Done



Doctors perform bone marrow aspirations and biopsies when they're
concerned about a problem in the bone marrow. They can help to diagnose:

• the cause of anemia (too few red blood cells, which carry oxygen through the body)
  
• the cause of thrombocytopenia (too few platelets, which help the blood to clot)
  
• the cause of an abnormal number of white blood cells, which fight infections
  
• cancers of the blood, such as leukemia
  
• whether cancers that started elsewhere have spread to the bone
  marrow (the assessment of how much a cancer has spread is called
  staging, and is important in determining treatment and prognosis)
  
• viral, bacterial, or fungal infections in the bone marrow that might be causing persistent fever or other symptoms
  
• certain genetic diseases (such as lipid storage diseases)
  

They also may be done to collect a bone marrow sample for procedures
(such as stem cell transplantation) or other testing (such as
chromosomal analysis).Preparation



After the procedure is explained and all of your questions have been
answered, you'll be asked to sign an informed consent form — this states
that you understand the procedure and its risks and alternatives and
give your permission for it to be performed.

The person performing the bone marrow aspiration and biopsy will know
your child's medical history, but might ask additional questions, such
as what medicines your child is taking or whether he or she has any
allergies. Be sure to report any bleeding tendencies in your child, and
whether your daughter might be pregnant.

Numbing cream may be placed on the aspiration and biopsy site about
30 minutes before the procedure. Your child will probably receive
sedation just before the procedure begins. He or she will be asked to
stop eating and drinking at a certain point earlier to make sure the
stomach is empty. Sedation medications are usually given through an IV
line (intravenous tube) and help patients stay asleep during the entire
test.

You might be able to stay in the room with your child during the
procedure for reassurance and support, or you can step outside to a
waiting area.
Procedure



A bone marrow aspiration and biopsy usually takes about 30 minutes.

Your child may be asked to change into a cloth gown, and then will be
positioned on an exam table on the stomach or side, and the skin will
be cleaned with a special soap.

If your child is sedated, the vital signs (heart rate, blood
pressure, temperature, and blood oxygen level) will be monitored during
the procedure. Your child may have a cuff around the upper arm to
measure blood pressure and a small fingertip clip to monitor the blood
oxygen level.

A small amount of anesthetic medicine will be injected through the
numb spot on the skin to prevent pain as the bone marrow needle is
inserted through the skin and soft tissues.

For the bone marrow aspiration, the doctor or nurse will carefully
insert a needle into the biopsy site and will then attach a syringe to
draw out a sample of fluid from inside the bone.

For the biopsy, a different kind of needle will be inserted into the
same area to remove a small sample of bone. A bandage will then be
applied to the biopsy site.


What to Expect



If your child is drowsy, the injected anesthetic may sting a bit for a
minute or two and he or she might also feel the pressure of the biopsy
needle pushing in. Some kids feel a quick sharp cramp as the liquid bone
marrow is withdrawn for the aspiration or as the sample of bone marrow
is removed for the biopsy. This cramp only lasts for a few seconds. In
many cases, sedation is to put children into a deep sleep so they won't
feel anything.

Depending on the doctor's recommendations, your child might have to
lie down for a while after the procedure. If sedated, your child may
need a few hours to rest.

The biopsy site may feel slightly sore the day after the procedure
and might have a small bruise. The bandage should be left in place for
as long as instructed by the doctor.

Getting the Results



A doctor with expertise in interpreting bone marrow biopsies will
look at the biopsy sample under a microscope and then give the
information to your doctor, who will review the results with you.

In an emergency, the results of a biopsy can be available quickly.
Otherwise, they're usually ready in 1-2 days. Results can't be given
directly to the patient or family at the time of the test.

If a bacterial infection is suspected, a culture is sent to a lab and
results are usually available in 48 hours. A doctor may start
antibiotic treatment while waiting for the results of the culture.

Risks



A bone marrow biopsy is considered a safe procedure with minimal
risks. Complications are rare. In some instances, there may some
discomfort or pain at the biopsy site for 1-2 days. In rare cases,
infection or bleeding can occur.

If your child is sedated, there's a slight chance of slowed breathing
due to the medications. If there are any problems with the sedation,
the medical staff will treat them right away.

Helping Your Child



You can help prepare your child for a bone marrow aspiration or
biopsy by explaining that while the test might be uncomfortable, it
won't take long. Explain the procedure in simple language, and make sure
the child understands where on his or her body the biopsy will be
performed. After the procedure, follow any instructions the doctor gives
you.

If You Have Questions



If you have questions about the bone marrow aspiration and biopsy,
speak with your doctor. You can also talk to the nurse or doctor before
the procedure.