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Bone Marrow Examination
During a bone marrow examination, samples of the liquid and solid portions of the bone marrow are collected. The bone marrow biopsy refers to a sample of the solid bone marrow material; a bone marrow aspiration is a sample of the liquid portion of the marrow.
Analysis of bone marrow provides a wealth of information about your blood cells that is necessary to diagnose leukemia. The results can also be used to classify the leukemia, direct treatment, and evaluate the effectiveness of treatment. Biopsy and aspiration of bone marrow is an invasive and painful procedure that is usually only performed after the analysis of blood samples.
Bone marrow samples are usually collected from the back of the hipbone in an area known as the posterior iliac crest. This procedure is usually performed in a medical center as an outpatient, using conscious sedation. Given through an IV, conscious sedation uses medications to minimize pain and make it less likely that you'll remember the procedure but it also adds on a couple more hours to the procedure in comparison with local anesthesia. Some people may prefer to use a local anesthesia, which reduces the pain of the procedure while involving less preparation and recovery time and fewer potential complications.
The bone marrow aspiration begins with the patient lying face down and on his or her side. After the doctor locates the hip bones at the top of the buttocks, the area is disinfected. The doctor inserts a thick hollow needle, about one third the width of a pencil, equipped with a handle on one end to help guide the needle into the bone. The needle is moved through the bone with a twisting motion. This procedure may cause a deep aching pain because the anesthetics are not able to numb the interior of the bones. A syringe is used to extract about 1 teaspoon of liquid bone marrow. If you are awake, the suction may cause a sharp stinging or pulling sensation that stops as soon as the sample is collected.
A bone marrow aspiration is usually followed by a bone marrow core biopsy in the same area. After the aspiration needle, the doctor carefully inserts a slightly larger needle farther into the bone marrow to collect a sample of the bone core. The core biopsy is a small solid piece of bone and marrow (about 1/16 inch in diameter and 1/2 inch long) that is removed. After the biopsy needle is removed, the core biopsy is extracted from the needle for examination under a microscope. The aspiration and biopsy usually take only about 30 minutes; but the entire examination may last two hours depending upon the type of anesthetic you receive.
After the procedure, pressure will be held against the biopsy site for a few minutes and a pressure dressing applied to reduce bleeding. Recovering from local anesthesia usually requires only 15 to 30 minutes. After that, you can return to normal activities at your discretion. If the procedure was done using IV sedation, you will need to stay at the health center until the sedative wears off. You will not be able to drive home. It may take up to 24 hours to regain full use of your judgment, memory, or response time after IV sedation.
At home, the pressure bandage needs to stay on and dry for 24 hours following the procedure. It's not unusual to experience a small amount of bleeding over the first 24 hours or feel pain for a week or so after a bone marrow biopsy and aspiration. However, if any of the following conditions develop, contact your healthcare provider:
• Excessive bleeding—soaks the bandage or doesn't stop with direct pressure
• Developing a fever above 100.4 degrees Fahrenheit
• Unrelenting pain
• Swelling, increasing redness, or drainage at the biopsy site
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