Bone Marrow Biopsy Pain

Bad to the Bone: Bone Marrow Biopsy Pain

Bone Marrow Biopsy Pain

Although it is not an uncommon procedure, bone marrow biopsies do have potential for complications. Patients may experience negative or allergic reactions to anesthesia, bleeding, bruising, infection, or prolonged discomfort and or pain at the source of the test. Although the risks are rare, it is crucial to take precaution and use the best tools and medical attention available.

What is bone marrow and what does it do?

Bone marrow contains cells that are supposed to produce a certain amount of white blood cells, red blood cells, and platelets. These cells and cell fragments work together on different tasks to help keep up a healthy body and lifestyle. White blood cells help to fight infections. Red blood cells carry oxygen and nutrients, and platelets enable the blood to clot. Unfortunately, sometimes the cells and cell fragments do not work as they are meant to, indicating there might be a more serious problem beyond the bones.  
If you are curious or concerned about your blood count, consider a complete blood count (CBC) test, that would measure and give information on: the number of red blood cells, the number of white blood cells, total hemoglobin count in the blood, the fraction of the blood composed of red blood cells, the average red blood cell size, the hemoglobin amount per red blood cell, the amount of hemoglobin relative to the size of the cell per red blood cell, and the platelet count.

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What happens during the procedure?

During the procedure, which takes about ten to twenty minutes, a small amount of bone marrow is taken from the bone, and taken for inspection in a laboratory to test for infection, disease, or other problems relating to the bone.  Bone marrow, a generally spongy tissue, contains both solid and liquid parts. A bone marrow biopsy is classified when samples are taken from the solid part of the bone, and found inside the hollow portion. As opposed to an aspiration, in which the liquid portion of bone marrow is extracted. Both procedures may be necessary, for the fullest understanding of what is happening inside your body.

What will the results reveal?

By proceeding with a bone marrow biopsy, your doctor may check for possible diseases and conditions such as anemia (indicating a low red blood cell count), myelofibrosis, myelodysplastic syndrome, or other bone marrow diseases, hemochromatosis (a genetic disorder in which iron builds in the blood), infection, and cancers of the bone marrow or blood. By reviewing the results of these tests, doctors can track the existence of these problems, if they have spread, and if they have responded to any preexisting treatments. The most common reason to perform a bone lesion biopsy, however, is to determine the difference between benign and malignant bone tumors, identify other bone abnormalities, and find the cause of bone pain and tenderness.

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How to prepare

According to The New England Journal of Medicine, to perform a proper bone marrow aspiration and biopsy, the necessary tools include sterile solution, drapes, gloves, local anesthesia, a needle with two syringes for administration of local anesthetic, an 11-blade scalpel for stab incision, two larger syringes, a bone marrow aspiration needle, a bone marrow biopsy needle, slides, preservative-free heparin sulfate, and possibly formalin or other fixative.

For a smooth procedure, prior to the exam, be sure to talk to your health care provider and ask any questions you may have regarding the procedure and the preparation. Mention if you are allergic to or taking any medications, both prescribed and over-the-counter, as well as herbal supplements, latex, tape, and anesthetic agents, as they will be used throughout the procedure. Notify your doctor if you or anyone in your family has had bleeding disorders, or if you are taking anticoagulant (blood-thinning) medications, or others that affect blood clotting. Your doctor may have you temporarily stop taking your medications for the duration of the procedure, but do not suspend your medication intake unless specified by your doctor. Notify your doctor too if you are pregnant, or may become pregnant. You may have to avoid eating a few hours before the procedure for precaution.

The procedure may be done in a health care provider’s office or in a hospital. Arrange your day accordingly. You may want to consider a ride home, as you may experience some pain following the procedure, or may experience the effects of medicine and sedatives. Not to worry– the procedure is common, and, if needed, you will be given medicine to help relax.

Before removing the sample, the health care provider cleans the skin and injects numbing medicine into the bone. As this is done, expect to feel a sharp sting. Once the numbing has kicked in, a biopsy needle is inserted into the bone. Often times, the test is taken either from the pelvis, also known as the iliac crest, or the breast bone, referred to as the sternum. However, sometimes other areas are used as well, such as the lower leg bone, or tibia, or the vertebra– backbone.

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After the procedure

Normal results will indicate that the bone marrow contains the proper number and types of  hematopoietic cells, or blood-forming cells, fat cells, and connective tissues.

Following the procedure, be sure to keep the area of the biopsy clean and dry. Follow your doctor’s orders, and be sensitive to the affected area. If you experience soreness, feel free to take a pain reliever, as recommended by your healthcare provider. If you experience fever, redness, swelling, bleeding, pain or drainage from the biopsy site, notify your doctor right away. Otherwise, feel free to resume your natural diet and activities unless otherwise specified.

Your bone marrow samples will be sent in to hematology and pathology laboratories for further testing. Your doctor will receive and review the results for evidence of disease, infections, or other problems. Be sure to consult your healthcare provider with the next steps that would make the most sense for you.


References:

“CBC Blood Test: MedlinePlus Medical Encyclopedia.” U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 20 Jan. 2016. <https://www.nlm.nih.gov/medlineplus/ency/article/003642.htm>.

“On a Scale of 0 to 10, How Painful Would You Rate Your Last Bone Marrow Biopsy?” The Myeloma Beacon. N.p., 28 Mar. 2012. Web. <http://www.myelomabeacon.com/forum/weekly-poll-bone-marrow-biopsies-and-pain-t944.html>.

Hjortholm, Nikolaj et al. “Strategies of Pain Reduction during the Bone Marrow Biopsy.” Annals of Hematology 92.2 (2013): 145–149. PMC. Web. 20 Jan. 2016.

About the Author: Sarah Lisovich

Sarah Lisovich is a Chicago based writer, editor, and content strategist at CIA Medical. The young author has published writing on multiple print and online publications and has received the Marion and David Stocking Prize for nonfiction writing. With creative writing, communications and marketing, and public relations experience, the up and coming creative thrives in multimedia publications and looks forward to applying her skills to learn, explore, and write about the wonderful world of medicine.