How long does a bone marrow biopsy take

Your treating doctor will discuss the reasons for this test before arranging this procedure. This procedure is performed as a day case by either a Haematologist or Haematology Registrar. Over 1,000 bone marrow biopsies are performed each year at Peter Mac.

Types of bone marrow biopsies

The bone marrow biopsy is almost always taken from the back of the pelvis bone where the large bone of the iliac crest is readily and safely accessible. Rarely, there may be a need to do the biopsy from the front (anterior iliac crest), or even the sternum (breast bone).

Preparing for your procedure

It is recommended that you fast from midnight on the day before your procedure, unless you definitely know you will not be receiving or choosing sedation of any kind.
It is advisable to wear loose fitting comfortable clothing.
Please inform the staff if you are taking anticoagulant drugs (“blood thinners”) such as warfarin, clexane, clopidogrel or other anticoagulants.
Please arrange for someone to assist you travelling home after the procedure.

Note: driving and operating machinery is prohibited for the remainder of the day, after any type of sedation.

On the day

Where to go

Imaging 5th floor, reception 5B Imaging via the main lifts.

The front inquiry desk will be happy to direct you. Remember not eat or drink anything before your procedure.

Premedication

Local anaesthesia is used for all patients. It gives good pain cover and many patients find this sufficient without requiring additional sedation or analgesia.

The team will discuss with you and aid your choice regarding a premedication with either an inhaler or an intravenous injection (if medically fit):

Inhaled sedation (methoxyflurane/Penthrox, also known as the ‘green whistle’) – an inhaled light acting pain relief.
Intravenous sedation (midazolam) - provides quicker and deeper sedation/drowsiness for patients. This is administered through a cannula which is inserted into an arm vein.
Oral sedation (diazepam or lorazepam) is rarely used – It is a light sedation given to reduce anxiety and discomfort.

During your procedure

You will be positioned on your side. Local anaesthesia will be given to numb a small area of the skin and on top of your pelvis bone. A very small cut in the skin is made (less than 0.5cm). A needle is inserted through the cut and a liquid sample (aspirate) is withdrawn and this is used to make slides, and perform other molecular and immunological tests. A core of tissue (trephine) the size of a matchstick is then removed. The procedure is reasonably quick, but at times can be uncomfortable. Most patients find the discomfort mild and tolerable.

All patients undergoing a bone marrow biopsy are asked to participate in the Peter Mac Tumour Bank Programme. Additional samples of blood and bone marrow are taken at the same time as the procedure and are either used fresh or stored as a potential resource for future research. You may be asked to sign a separate consent form for participation in this programme. Participation in the programme is voluntary and you can opt out anytime.

After your procedure

You will be required to remain under the care of nursing staff until you are discharged. If you receive intravenous sedation you will be required to stay for a minimum of two hours prior to being discharged to a carer.

After 24 hours the small waterproof dressing on the biopsy site can be removed and a clean dressing reapplied. A spare dressing and instructions will be given to you on the day of your procedure.

What to bring

Please remember to wear loose fitting comfortable clothing.

Please bring a list of your medications and any letters or pathology request slips that your doctor may have given you for this procedure.

Side effects and possible complications

Bruising and discomfort over the area are common for up to one week post biopsy. Bleeding or infection at the biopsy site are rare complications. Please notify your doctor if the site becomes red, hot or if bleeding persists.

Amnesia (no memory) of the procedure this is common with intravenous sedation. Your normal memory will not be affected once the sedation has worn off.

Safety and sedation: you are advised not to drive, operate machinery or consume alcohol for the remainder of the day.

If you have any problems following the procedure please contact the Cancer Imaging Day Centre on (03) 8559 5510 during work hours, your treating doctor or the haematology registrar after hours via the Peter Mac switch board on (03) 8559 5000.

Getting your results

The results will be sent to your doctor in two to seven days.

Referral information

For patients

Your general practitioner or specialist will organise relevant referrals for a Bone marrow biopsy.

For medical professionals

Bone marrow biopsy bookings are to be booked through the Cancer Imaging Access Coordinator, on

Phone: (03) 8559 5142

Fax: (03) 8559 5519

Or alternatively by email: [email protected]

They must be made by close of business the day prior. Numbers are limited, but urgent cases/ additions to the daily list should be discussed with the duty Laboratory Haematology Registrar or the access coordinator.

Minimum patient information required

a. Patient’s full name, DOB

b. UR number

c. Diagnosis/ clinical notes/ indication for procedure

d. Name of Treating Team, requesting Doctor & contact details including pager number & the primary consultant

f. Notification of VRE, MRSA and/or any infections requiring isolation is highly essential

For general information on referring patients to Peter Mac see referrals.

Location

Cancer Imaging Day Centre

level 5, reception 5B Imaging

Peter MacCallum Cancer Centre

305 Grattan Street

Melbourne, 3000

Contact

Imaging

Phone: (03) 8559 5510

Fax: (03) 8559 5519

Consultant Haematopathologist

Director of Digital and Healthcare Innovations

Bone marrow is the spongy, fatty tissue found inside the body's larger bones. It has liquid and solid parts. Bone marrow makes these types of blood cells:

Red blood cells carry oxygen to all parts of the body.
White blood cells help the body fight infection and disease.
Platelets help the blood clot and control bleeding.

Sometimes doctors need to see how well these cells develop and work. To do this, they may recommend a bone marrow aspiration and/or a bone marrow biopsy. These procedures collect a sample of bone marrow.

The results of a bone marrow aspiration and/or biopsy help doctors find out about these conditions:

Blood cancers, including leukemia, lymphoma, or multiple myeloma
A fever with an unknown cause
Stem cell disorders
Rare genetic diseases

Doctors can also use the results from these procedures to better understand a blood cancer, including its subtype and stage, determine whether a treatment is working, and monitor any side effects of chemotherapy.

What is a bone marrow aspiration and biopsy?

Bone marrow aspiration is a procedure that removes a sample of the liquid portion of bone marrow.
A bone marrow biopsy removes a small, solid piece of bone marrow.

In both procedures, the bone marrow sample usually comes from the pelvic bone. This bone is in your lower back by your hip. Doctors often do these 2 procedures at the same time. They refer to them together as a bone marrow examination. Your doctor will decide whether you need 1 or both procedures.

Who does a bone marrow aspiration and biopsy? Who analyzes the sample?

An oncologist, hematologist, another doctor, or a specially trained technologist will perform the bone marrow aspiration and biopsy.

A doctor who specializes in interpreting laboratory tests will look at the collected bone marrow cells under a microscope. This doctor is called a pathologist. The pathologist then gives the results to your doctor in a pathology report.

Getting ready for a bone marrow aspiration and biopsy

When you schedule your procedure, you will get a detailed explanation of how to prepare.

What to eat. You can usually eat or drink normally before the test. Ask your health care team ahead of time to make sure.

Topics to talk about with your health care team. You may not be able to take certain medications, such as blood thinners, before your procedure. Tell your health care team about all medications and supplements you take. Ask whether you should take them on your procedure day. You should also bring up any test concerns you have.

Insurance and cost. Before your appointment, contact your insurance provider. Find out how much of the procedure’s costs it will cover and ask how much you will have to pay.

Consent. The doctor's office or hospital will ask you to sign a consent form when you arrive for the procedure. This form states that you understand the procedure’s benefits and risks. The form also states that you agree to the procedure. If you have concerns about the procedure, talk with your doctor before you sign.

During the procedure

Where will the procedure take place? Medical specialists do bone marrow aspiration and biopsy procedures in a hospital, clinic, or their office.

How long will the procedure take? When done together, the 2 procedures usually take about 30 minutes.

What happens during the procedure?

You will receive a local anesthetic to block pain. You may also have the option to take medicine before the procedure to help you relax. Tell your health care team if you have ever had an allergic reaction to an anesthetic or if you are nervous.

In addition to local anesthetic, your doctor may suggest conscious sedation. This type of anesthesia uses pain relievers and sedatives. Under conscious sedation, you will stay awake but feel no pain. You will also have little to no memory of the procedure. Most people only receive local anesthetic for bone marrow aspirations and biopsies.

If the procedure site is your pelvic bone, you will lie on your stomach or side. You will be on an examination table or hospital bed. The medical specialist will clean the skin around the bone with an antiseptic solution. Then the specialist will inject the local anesthetic through the skin with a small needle. The medicine will go into the tissue next to the bone. You will feel a slight stinging sensation. Then the area will go numb.

If you need both procedures, bone marrow aspiration usually comes first. The doctor inserts a hollow needle into the numbed area and pushes gently into the bone. Then, he or she removes the center portion of the hollow needle and attaches a syringe to the needle. The syringe withdraws the liquid portion of the bone marrow. You may feel a deep, dull, aching pain for a few seconds, similar to a toothache. It may help to squeeze a pillow or someone’s hand. After the needle comes out, the pain goes away.

For the bone marrow biopsy, the medical specialist inserts a larger needle into the same area. They will guide the needle into the bone and rotate it to remove a sample of tissue. You may feel pain and pressure as the needle moves into the bone. The medical specialist will then remove the entire needle. Next, they will place a bandage over the site to prevent bleeding.

After the procedure

If your procedure takes place at a clinic, you can go home shortly after it is over. But if you received sedation, you will first need to lie down for about 20 minutes. That way the medicine’s effects can wear off. You will also need a ride home after sedation. Be sure to make transportation arrangements before the procedure.

What should I expect after returning home?

Once you are home, keep the area around the bandage clean and dry. Ask your doctor when you can remove it. Do not shower or bathe until then. You will likely see some blood on the dressing. This is normal. You can then cover the wound with a bandage until it fully heals.

You may feel discomfort at the needle insertion site. This can last for several days, especially when bending over. Some people may also feel pain down the back of their leg. Mild bruising is normal. It can show up several days after the procedure.

Tell your doctor if you have any of these problems after the procedure:

Fever of 101 degrees Fahrenheit/38.3 degrees Celsius or higher
Bleeding that does not stop easily
Unusual discharge or severe pain at the needle insertion site
Any other signs or symptoms of infection

Questions to ask the health care team

Consider asking these questions before you have a bone marrow aspiration or biopsy:

Who will do the procedure?
What will happen during the procedure?
How long will the procedure take?
What are the risks and benefits of having the procedure?
Will I be awake or asleep during the procedure?
Will I feel any pain during the procedure? If so, for how long? What can reduce the pain?
Can I take my usual medications the day of this procedure?
Will I need to avoid any activities after the procedure?
Can you tell me how to care for the wound?
When will I learn the results?
Who will explain the results to me? Will I need more tests if the results suggest cancer?