Background Information:

What are the other Names for the Procedure?

• Bone Marrow Aspirate
• Bone Marrow Aspirate and Biopsy
• Bone Marrow Aspirate and Trephine Biopsy

What is Bone Marrow Aspiration & Biopsy surgical procedure?

• Bone Marrow Aspiration & Biopsy is a procedure that involves removal and examination of the bone marrow
• The bone marrow is a tissue within the bone, responsible for producing blood components, like red blood cells and white blood cells
• This test enables detecting various diseases of the blood and bone marrow, including cancer

What part of the Body does the Procedure involve?

• A Bone Marrow Aspiration & Biopsy usually involves the pelvis bone
• But, it can also be performed on the breast bone (sternum), or a leg bone (below the knee, above the foot)

Why is the Bone Marrow Aspiration & Biopsy surgical procedure Performed?

There could be various reasons for performing a Bone Marrow Aspiration & Biopsy procedure. Some of the indications are:

• To check for medical problems in the blood, blood cells, etc.
• To check for bone marrow disorders
• Abnormal white blood cell count
• Hodgkin’s Lymphoma
• To inspect and verify if a cancer has spread to the bone marrow
• Leukemia
• Anemia
• To examine the stage of progression of a disease
• To monitor the treatment of a disease

What are some Alternative Choices for the Procedure?

To study and diagnose any ailment related to the blood & bone marrow, this procedure remains the gold standard technique.

What are the Recent Advances in the Procedure?

Some of the advancements in Bone Marrow Aspiration & Biopsy procedure are related to the usage of devices that uses mechanical force to perform the procedure instead of manual pressure, for needle insertion.

What is the Cost of performing the Bone Marrow Aspiration & Biopsy surgical procedure?

The cost of Bone Marrow Aspiration & Biopsy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Bone Marrow Aspiration & Biopsy and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

What are some Helpful Resources?

http://www.mayoclinic.com/health/bone-marrow-biopsy/MY00305/DSECTION=what-you-can-expect

http://www.vidacare.com/oncontrol/Bone-Marrow.aspx

Prior to Bone Marrow Aspiration & Biopsy surgical procedure:

How is the Bone Marrow Aspiration & Biopsy surgical procedure Performed?

• The person is made to lie on their sides or on their belly facing down. The spot on the body where the needle is to be inserted, is cleansed with a medical solution and local anesthesia administered
• A large hollow needle is inserted through the skin, muscle, tissue and finally into the bone
• The surgeon uses twisting hand motion to penetrate the bone and push the needle into the bone marrow cavity. The liquid bone marrow is then extracted and the needle withdrawn
• The procedure is repeated again to extract a sample of solid bone marrow
• After the Bone Marrow Aspiration & Biopsy procedure is complete, pressure is applied to the area to arrest bleeding and it is bandaged

Where is the Procedure Performed?

The procedure is usually performed in an out-patient surgery center facility or at the physician’s office. The patient is discharged once the procedure is complete.

Who Performs the Procedure?

A Bone Marrow Aspiration & Biopsy procedure can be performed by any of these medical professionals: Hematologist, oncologist, pathologist, or any other qualified and trained healthcare provider.

How long will the Procedure take?

The procedure takes anywhere between 15-30 minutes. If necessary, the physician may ask the patient to wait for a longer period of time at the healthcare facility for further observation post-procedure.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Since local anesthesia is normally used; do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

A physician will request your consent for the Bone Marrow Aspiration & Biopsy procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Bone Marrow Aspiration & Biopsy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Bone Marrow Aspiration & Biopsy surgical procedure?

Some blood tests may be necessary prior to the procedure. The physician determines the extent of blood tests that are required.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Bone Marrow Aspiration & Biopsy procedure?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the possible complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Bone Marrow Aspiration & Biopsy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

• During the procedure the patient is administered local anesthesia either with, or without sedation
• However, in some cases, general anesthesia may be administered. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility

How much Blood will you lose, during the Procedure?

Since the procedure only involves inserting a needle in the bone and is minimally invasive, the blood loss involved is also minimal.

What are the possible Risks and Complications during the Bone Marrow Aspiration & Biopsy surgical procedure?

The possible risks or complications that may arise during the procedure are:

• Infection
• Accidental injury to the neighboring tissue or bone
• Bleeding from the site of needle puncture
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Bone Marrow Aspiration & Biopsy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Bone Marrow Aspiration & Biopsy surgical procedure:

What are the possible Risks and Complications after the Bone Marrow Aspiration & Biopsy surgical procedure?

The complications that may arise after a Bone Marrow Aspiration & Biopsy procedure are:

• Infection
• Bleeding from the needle puncture site

What is the Prognosis after the Surgery?

The Bone Marrow Aspiration & Biopsy procedure provides information that helps in the successful diagnosis (or elimination) of blood or bone marrow related disorders. The recovery from the procedure is generally excellent.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain
• Swelling or redness
• Bleeding or fluid drainage from the needle insertion point
• Fever
• Muscle ache
• Dizziness
• Nausea or vomiting

What Post-Operative Care is needed at Home after the Bone Marrow Aspiration & Biopsy surgical procedure?

At home, the following post-operative care is recommended, after a Bone Marrow Aspiration & Biopsy procedure:

• Keep the puncture site clean and dry; wash with mild soap while bathing
• Use ice packs to reduce swelling and bleeding, or follow directions of the physician
• Resume normal daily activities, per physician’s advice
• Avoid non-prescribed medications

How long does it normally take to fully recover, from the Procedure?

It takes about a day or two, to completely recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Bone Marrow Aspiration & Biopsy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• A hematologist or an oncologist or a pathologist (if the pathologist performs the procedure)
• An anesthesiologist (if anesthesia was administered)
• A pathologist (for analyzing the tissue)

The patient is advised to inquire and confirm the type of billing, before the Bone Marrow Aspiration & Biopsy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA