Bone marrow tests for lymphoma

Transcription

1 Freephone helpline Your doctor has recommended that you have a bone marrow test to find out more about your lymphoma and its treatment. This article aims to answer the most common questions people ask about having this test done: Why am I having a bone marrow test? What is bone marrow? What happens in a bone marrow test? What does the test feel like does it hurt? What are the risks of the procedure? Where do the specimens go? When will I get the results? Why am I having a bone marrow test? If your doctor has recommended that you have a bone marrow test they will explain why this is needed. There are several reasons for having bone marrow tests, for example to: confirm the diagnosis of a bone marrow lymphoma (or to rule it out) find out whether a lymphoma found elsewhere in the body is also present in the bone marrow or not (as part of the staging process) check on the effect of a course of treatment, to see if the marrow is now clear assess blood production if blood tests are showing that the blood cell counts are low. What is bone marrow? Your blood cells are made in the bone marrow spongy, jelly-like tissue and fluid that is found inside the bigger bones of the body. When we are babies blood cells are made in nearly all our bones but as we grow up some of the marrow in the smaller bones becomes fatty. Blood production continues mostly in the more central bones, such as the thighs, breastbone, pelvis and back bones. The bone marrow contains the immature blood cells the stem cells which develop into mature, working cells that are released into the bloodstream to carry out their jobs. 1/5

2 What happens in a bone marrow test? Bone marrow tests are usually done in a day-case unit often there will be other patients having other procedures or treatments while you are there. If you are in hospital you may be taken there, or the procedure might be carried out in your hospital bed. You can eat and drink normally beforehand if you are not having a sedative (see page 3). The procedure takes around 20 minutes to do and you will need to rest for 2 3 hours afterwards. A needle is inserted into the marrow space (the softer bit in the middle of the bone, where the marrow is found) to obtain samples. A tiny amount is taken your body will have made it up a few hours later. Two types of sample are taken: bone marrow aspirate, which is a liquid specimen; everyone has this taken ( aspirate is fluid that has been drawn off by suction) bone marrow trephine biopsy, which involves removing a small sample of bone marrow tissue (a trephine is a surgical instrument that removes a small circle of tissue). If you are only having an aspirate this might be taken from the sternum (the breastbone) or the pelvis (the hip bone, to the right of the lower part of your back). The sternum is sometimes used if you are only having an aspirate because it can often be quicker and easier, as well as providing better specimens. If you are also having a trephine biopsy then both samples will be taken from the pelvis. People with lymphoma usually have both an aspirate and a trephine biopsy done. If you are having a test from the sternum you will lie on your back for the test. If the doctors are taking the marrow sample from your pelvis you will usually lie on your side. Bone marrow test Bone marrow Bone Skin Biopsy needle 2/5

3 What does the test feel like does it hurt? Having a bone marrow test can be uncomfortable, so you will be given an injection of local anaesthetic beforehand. The anaesthetic is injected just under the skin over the bone that is going to be tested. This can sting a little when it goes in but will make the area numb. Please say if you are particularly uncomfortable at any time during the test and the doctor or nurse will try to help. Once the area is numb a needle is passed through the skin into the bone and a little liquid bone marrow is drawn out into a syringe. When the aspirate is taken there can be a pulling feeling as the inside lining of the marrow stretches a bit this can be uncomfortable or sometimes painful but it passes off almost immediately. If you are also having a trephine biopsy, you might then feel a pushing sensation as the sample of the bone marrow is taken. There can be a feeling of pressure building up, which also passes off quickly. Some people find the noise of the needle going in a bit unpleasant but again this only lasts a few moments. In some centres marrow tests are done using a fine drill, so you might hear this being used. If you found a previous marrow painful, or are frightened by the prospect, or just know you would prefer to be a bit sleepy then please ask about having some sedation before having the test. The staff will be very happy to talk to you about this. You might not be able to eat or drink for a while before having a sedative but you will be advised about this. What happens afterwards? After the needle is removed a dressing will be applied. You will need to stay lying down for an hour or two and you will be monitored to make sure there is no bleeding. The procedure should not affect your mobility afterwards. Once you are up from the bed or couch it will probably be suggested that you rest in the waiting room and have a drink before you go home. If you have had a sedative you will be drowsy for a while afterwards and should not drive home or travel on your own. You should bring someone with you who can take you home afterwards. When the local anaesthetic wears off (this takes 2 3 hours), the test site can be sore, though most people say they are surprised at how mild this is. Taking regular painkillers such as paracetamol over the following few days if you need to will ease the discomfort. What are the risks of the procedure? Most people experience no side effects at all after a bone marrow test. Occasionally there can be some bleeding from the biopsy site. This is more likely if your condition or any treatment you are on affects the clotting system or the platelets (these are specialised blood cell fragments that help the blood to clot). The puncture site will be checked before you leave. If it bleeds when you are at home and doesn t stop when you apply pressure, you should contact the unit for advice. 3/5

4 It is important to remind the doctors and nurses before the procedure if you are on any drug that affects the blood clotting system, for example if you are taking warfarin, heparin, aspirin or clopidogrel. If you are taking one of these medications you might be asked to continue with it or you might be advised how to stop it temporarily (this depends on the reason you are on the medicine and on other factors). If the biopsy site becomes increasingly painful, red or swollen (with or without a temperature) after you go home, please notify the hospital or attend the unit without delay in case you have developed an infection. This side effect happens very rarely. Where do the specimens go? The liquid from bone marrow aspirate is smeared onto glass slides straightaway. These slides are stained and looked at under the microscope. The trephine specimen will also be examined this way but it takes longer to process. Extra aspirate may be taken to send for other tests in local laboratories or to be sent away to other centres. Extra specimens may be sent elsewhere if you are treated on a clinical trial protocol. When will I get the results? In most hospitals the results will be discussed when you next attend the clinic, so please let the department know if you don t appear to have an appointment. Results are often scrutinised by your doctors as they come back if there is any reason why your team would like to see you sooner (or if that was the arrangement) you will be contacted before your scheduled appointment. Acknowledgement The Lymphoma Association is grateful to Dr Paul Revell, Consultant Haematologist, Stafford General Hospital, for writing this article. Useful organisations and further information Macmillan Cancer Support 89 Albert Embankment, London SE1 7UQ via website CancerHelp UK An information and advice service run by Cancer Research UK via website Patient.co.uk A useful article on bone marrow tests can be found at: 4/5

5 References Bucher CM, et al. Comparison of a powered bone marrow biopsy device with a manual system: results of a prospective randomised controlled trial. Journal of Clinical Pathology, 2012 October 26. Epub ahead of print. doi: /jclinpath ) Swords RT, et al. A prospective randomised study of a rotary powered device (OnControl) for bone marrow aspiration and biopsy. Journal of Clinical Pathology, : How we can help you We provide: a free helpline providing information and emotional support (9am 6pm Mondays Thursdays; 9am 5pm Fridays) or information@lymphomas.org.uk free information sheets and booklets about lymphoma a website with forums and a chatroom the opportunity to be put in touch with others affected by lymphoma through our buddy scheme a nationwide network of lymphoma support groups. How you can help us We continually strive to improve our information resources for people affected by lymphoma and we would be interested in any feedback you might have on this article. Please visit or publications@lymphomas.org.uk if you have any comments. Alternatively please phone our helpline on We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. The Lymphoma Association cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites which we link to. Please see our website ( for more information about how we produce our information. Lymphoma Association PO Box 386, Aylesbury, Bucks, HP20 2GA Registered charity no Produced Next revision due /5