Bone marrow is a spongy material inside the bones. Bone marrow produces the white blood cells, red blood cells and platelets found in the blood stream. Obtaining bone marrow tissue for pathological analysis is a common part of the diagnostic and staging work-up for the types of cancer - leukemia, lymphoma and myeloma - that can start in or spread to the bone marrow. Analysis of the bone marrow is also important in the diagnosis of a variety of other blood-related disorders like myelodysplastic syndrome (MDS) and chronic low or high blood cell counts. In addition to being an important step in diagnosis, bone marrow analysis can be repeated after treatment to help doctors determine if the therapy was effective.
If your oncologist or hematologist determines that bone marrow biopsy is indicated, your physician's office will give you an appointment time for the procedure to be performed on the 4th floor Short Stay unit, as well as written pre-procedure instructions and a description of the risks and benefits of the procedure. You can pre-register for the procedure by telephone by calling the hospital pre-registration office at (310) 517-4754. On the day of the bone marrow biopsy, you should report to the Torrance Memorial Admitting desk on the first floor of the main hospital about an hour before your biopsy is scheduled, even if you have pre-registered via telephone. You or your loved one can be confident that that procedure will be performed with the optimum safety and utmost concern for your comfort because the Torrance Memorial pathologists perform 350 bone marrow biopsies annually.
Bone marrow biopsy procedure can typically be done in less than 30 minutes. Because you will be receiving anesthesia, you will need to avoid eating food or drinking liquids for 12 hours before the biopsy procedure.
Since the large bones in the body contain the most marrow, these bones are the best choices for obtaining a specimen. The pathologist performing the biopsy will use the hip (pelvic) bone to withdraw the bone marrow sample because obtaining a specimen from this bone is quite safe and carries very minimal risk of any complications from the procedure. Because a bone marrow biopsy involves insertion of a needle into the bone, the skin over the bone will be cleaned with an iodine solution beforehand.
One of the primary goals of the pathologists at Torrance Memorial is to assure you or your loved one's complete comfort throughout the procedure. Although bone marrow biopsy can be performed after the area where the needle will be inserted is numbed with an injection of a local anesthetic like lidocaine, it is common for the patient to experience significant discomfort when this type of pain control is used. For that reason, all bone marrow biopsies at Torrance Memorial are performed with the assistance of an anesthesiologist so that the patient can be placed under conscious sedation for the procedure.
Conscious sedation includes the IV administration of the medication propofol. Conscious sedation is provided throughout the procedure to achieve the optimum pain control by maintaining the patient in a state of sleep throughout the procedure.
Conscious sedation is very safe--all patients undergoing conscious sedation receive constant monitoring of their vital signs throughout the procedure. Because propofol is short-acting, that is, the effect of the drug wears off rapidly once the infusion is stopped, you or a loved one can expect to awaken quickly with minimal grogginess. It is common to experience amnesia for the procedure. Patients who receive propofol usually do not experience any of the side effects commonly experienced with other types of anesthetics and pain medications such as headache, drowsiness, nausea, vomiting, or unpleasant memory of the procedure.
Once you have fully awakened, you will be able to go home after about 90 minutes. You will be given printed post-procedure instructions which include not driving, operating dangerous equipment or making important decisions for at least 24 hours. You can expect to have a mild to moderate ache where the needle was inserted for a day or so after the procedure. Acetaminophen (Tylenol®) is recommended for pain relief. Any unexpected or worsening side effects should be reported to your physician who ordered the biopsy procedure.
Analysis of the bone marrow tissue includes several types of tests, most of which will be completed in 3 to 4 days. The bone marrow specimen is reviewed by more than one pathologist and usually by a hematopathologist (pathologist who specializes in the analysis of bone marrow tissue). A formal written report will be sent to your physician who ordered the biopsy procedure.