Bone Marrow Biopsy

What is bone marrow?

Bone marrow is a soft and spongy tissue present inside the bones. These tissues contain stem cells. The primary function of the stem cells is to produce red blood cells in the body that help in the circulation of oxygen via the bloodstream. The bone marrow also produces WBCs or white blood cells that help combat infections and platelets, the component of blood that helps in clotting.

The human body has two types of bone marrow tissue – red and yellow. Most of the bone marrow present in the human body is red, which gradually turns to yellow because of fatty depositions. Thus, the red bone marrow tissues provide a much more accurate picture of the blood vessels and other related conditions and this sample is collected during a bone marrow biopsy.

What is a bone marrow biopsy?

A bone marrow biopsy is a procedure in which a patient’s bone marrow sample is extracted and collected, and examined for abnormalities in the blood cells.  It checks whether the production of the blood cells is normal or not and also how healthy or unhealthy the bone marrow tissues are.

The bone marrow is extracted by the help of a needle inserted in the hip area bones (the larger bones in the body where red bone marrow is present). The sample is then sent to labs to check for any abnormalities, including cancer.

Why has the doctor asked me to undergo a bone marrow biopsy?

If your doctor has suggested that you undergo a bone marrow biopsy, then high chances are that the doctor suspects that you have issues with healthy blood cell production. It could pertain to insufficient RBCs in the bloodstream or even low/high platelets and WBC count in the body. When there is an imbalance in the normal blood cell count in the body, a patient will exhibit at least one of the following symptoms:

– Anemia (insufficient RBCs) seen through pale skin, extreme fatigue, and shortness of breath

– Excessive bleeding following an injury or cut (low clotting factor)

– Bone marrow cancers (leukemia, myeloma, or lymphoma)

– Unexplained fever with very high body temperature

– Malignancy that has spread to the bone marrow

Since the blood cells primary functions are oxygen transportation and fighting off infections,  a bone marrow biopsy is often prescribed to patients who either show symptoms of fatigue and infections or that of cancer. Additionally, if a patient is undergoing chemotherapy, a bone marrow biopsy might be recommended by a doctor to assess the prognosis of the current cancer treatment.

What conditions can be diagnosed through a bone marrow biopsy?

As mentioned before, there are specific blood cells that are responsible for critical functions in the body. A bone marrow biopsy can thus help diagnose or screen (or rule out) the presence of the following diseases and health conditions:

– Anemia or iron deficiency
– Cancers such as leukemia, lymphoma, or myeloma
– Low platelet count or thrombocytopenia
– Hemophilia
– Excessive blood clotting
– Leukopenia or polycythemia
– Hemochromatosis or excess iron in the blood
– Infection in the blood of unexplained origin

How much does bone marrow biopsy procedure cost in India?

The average cost of bone marrow biopsy in India lies with the range of Rs. 1000 to Rs 5000, varying across cities and medical facilities. However, it must be noted that this is the cost associated with basic marrow evaluation. There might be further costs involved in case there are more procedures or evaluation that need to be performed on the bone marrow sample.

How many people in India are diagnosed with blood cancer every year?

Every year in India, more than 10,000 cases of leukemia are reported. Almost 85 % of these cases belong to the category of childhood leukemia. It has been observed that blood cancers are more commonly prevalent in children and among the population above the age of 55 years.

How do I prepare for a bone marrow biopsy procedure?

– Provide the doctor/healthcare specialist with your complete medical history before the procedure.

– Tell your doctor if you are any of these medications – blood thinners, common painkillers such as aspirin or ibuprofen, herbal treatments, and or anticoagulants. This is critical information since the bone marrow biopsy procedure carries the risk of excessive bleeding.

– You need to also provide information if you are allergic to any drugs or medications or latex.

– It is important to have someone drive you back home after the procedure is complete.

How is a bone marrow biopsy performed?

Bone marrow biopsy is often accompanied by bone marrow aspiration, the process removal of fluid from the marrow for examination. This is usually done as an out-patient procedure but some patients might need to stay in the hospital for a day or two. The following steps are followed in the procedure:

– The patient is asked to change into a hospital gown and asked to lie on their side or stomach. Generally, the marrow is extracted from the hip bones (pelvic area bones).

– The site of marrow extraction is cleaned with an anesthetic.

-This part might cause some pain, as the needle is inserted and the liquid anesthetic enters the body.

– Once the area becomes numb, a small incision is made and initially bone marrow aspiration is performed. A syringe is used to extract the liquid bone marrow component.

– After this step comes, the marrow extraction. A needle used for bone marrow extraction is larger than the aspiration needle. The marrow needle will be inserted into the site and rotated to extract a sample of the bone marrow tissues.

– Firm pressure will be applied to the incision site to stop the bleeding.

– The area is covered with a sterile material such as a bandage to prevent bleeding and infections.

-The bone marrow sample is sent to the labs for examination for abnormal cells.

Is this procedure painful?

Some degree of pain is felt both during and after the procedure. There are some who feel the pain at the site of bone marrow extraction for a week, but most people don’t. Your doctor might prescribe you some painkillers in case the pain is high.  If you feel anxious about the pain, talk to your doctor beforehand. He might be able to suggest some pain-relieving or anti-anxiety pills for you before the procedure begins

What to do after the bone marrow biopsy procedure is over?

It is important to keep the area of incision completely dry for at 24 hours to cut down the risk of infections. You need to completely refrain from performing any strenuous activities for a few days. Anything that puts pressure on the incision site can increase the risk of bleeding and pain. You must avoid exercise, running, lifting, etc. for at least 48 hours. In case you feel the symptoms of fever, increased pain, bleeding, and infection at the site of needle insertion, refer to the doctor immediately.

Does bone marrow aspiration require fasting?

Usually, fasting is not required before a bone marrow biopsy; however, it is advised that the patient consume a light meal.

Can pregnant women undergo this procedure?

Yes, bone marrow biopsy and aspiration can be performed on pregnant women; however, it is important to tell your doctor if you are pregnant or if you think you might be pregnant. This should be done so that the doctor will know what exact kind of sedative/anesthetic to use.

Can infants and children under a bone marrow biopsy?

Yes, if the need arises, infants and children can undergo the procedure.  For them, general anesthesia is given instead of local anesthesia meant for adults.  Since in this case, anesthesia is general, the child needs to be on empty stomach for 6-8 hours before the procedure. For infants, breastfeeding/ formula can be provided 4-6 hours prior to the procedure but after that, they need to be on empty stomach, till the procedure is complete.

Are there any risks or complications associated with bone marrow biopsy?

This is a very safe procedure and the pain that is felt is usually for a brief period of time. Certain risks associated with bone marrow biopsy are – the risk of excessive bleeding, bruising and pain at the site of needle insertion, and infection.

When will I get my results?

It generally takes 1-3 weeks for the test results to come. Book a follow-up appointment with your doctor once the bone marrow autopsy result is out.

How to interpret a bone marrow biopsy report?

A bone marrow biopsy is done to analyze if your bone marrow tissues are in the normal state or not, and if not, what could be the reason. The pathologist will perform a series of tests on the marrow sample to find if you have some form of blood cancer (lymphoma or others) and what is the stage of cancer onset.

Abnormal results always do not mean cancer. It could be there because of some infection or any other disease of the marrow, if not cancer. In order to accurately diagnose what exact problem exists, your doctor may ask you to undergo further tests.