Published on May 8, 2018
Although a bone marrow biopsy can be done as an in-office procedure, newly diagnosed myeloproliferative neoplasm (MPN) patients may be shocked if they don’t know what to expect. What is the purpose of a bone marrow biopsy? How painful is the procedure? Expert, Dr. Laura Michaelis from the Medical College of Wisconsin explains how a bone marrow biopsy is performed, the potential risks and its value to your cancer care. MPN patient advocates, Jill and Nick, also share their first-time experiences receiving a bone marrow biopsy. What did they wish they knew beforehand? Watch now to learn more.
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Transcript | MPN Bone Marrow Biopsy: What Patients Should Expect
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I will mention one other thing about bone marrow biopsy, and Dr. Michaelis was just talking about it, it gives a lot of information. Now, us patients have had it. So, Jill, for people watching that never had it, the idea of a needle stuck in your hip is not a pleasant thing. What do you want to say about it? And I want to get Nick’s view, and I’ll give mine, too.
Well, I have to say, my first one with the local hematologist, I had no idea what it actually was. And I had just had a liver biopsy about a month ago, where it was like an outpatient thing. So when my local hematologist said we should really do a bone marrow biopsy, and we can just do it today here in the office, I thought to myself that can’t be any big deal. It’s just an office procedure. But when I walked out of there, I was just in total shock. I could not believe the procedure.
And maybe it was good that I didn’t know because—so, then, when I went down to MD Anderson, and, of course, they want to do their own bone marrow biopsy, and I thought, oh, my gosh, please don’t make me do this again.
But theirs was a piece of cake.
Yeah, they have people...
...practice makes perfect, I have decided.
Yeah. So, yeah.
Have someone experienced do it. Nick, how about you? You’ve had it, too.
Yeah. And so, very similar thoughts. When I went for my second opinion, the doctor said, well, we can do a bone marrow biopsy. I’d like to do one today. I said, okay, how bad could it be? And he was just staring at me. And he’s like are you sure, are you up for it? I said sure. And he even said we’d like to take a little extra out for some clinical trials. I said why not. But it tickled; I’ll put it that way.
Yeah. Well, I’ll just say, I want to get Dr. Michaelis’s opinion. So, I’ve had about 10 over the years because I’m dealing with an earlier leukemia, which has been controlled well, chronic lymphocytic leukemia.
And I would say, first of all, have someone who is experienced do it. One time, I had a community oncologist do it, and he’s up on the table, and he doesn’t do it very often. So, have someone who is experienced. Often, in some of the larger clinics, they have physician assistants or technicians who do it, and they do it all of the time, in a major center. And you’ll have a little bit of lidocaine or whatever. Some people, sometimes, get something more. But it gives them a lot of information. So, but Dr. Michaelis, it’s important information for you and the patient to make determinations. And so, I guess, what advice would you give people on these tests that we need?
Yeah. So, first off, it’s not—I do think it’s a very important one, to do at diagnosis. In terms of how often it needs to be done, it’s not like it needs to be done every three months or every six months or something. There’s no schedule for it. But what is important is that, if your disease looks different, if you’ve taken a treatment, and now, things look new or different, or if you’re on a clinical trial, or if things look worse, sometimes, that’s the time to repeat it.
I would echo exactly what you said, Andrew. Have somebody who has done a lot of them do it. At our center, the physician assistant I work with has done something like 1,300 of them. So, she knows when it’s going to be a touch one. And if it’s going to be a tough one, sometimes, she’ll arrange for the radiologist to do it in a radiological suite. Here, we do not put people to sleep for it because, actually, the anesthesia carries more risks than the procedure does. I think with everything you go through in medicine, a little bit more information beforehand can be helpful.
So, Jill, I’m sorry that somebody didn’t say this is what happens in a bone marrow biopsy. You’re going to lay on your stomach. We’re going to numb a little bit of the back of your pelvis bone with procaine (Novocain) like you get in a doctor’s office.
When you lay on your stomach, your hip bones sits about 3 centimeters from your skin, which means that we can go in with a needle and numb up the outside of that hip bone. When we put the hollow needle through the skin and into the hip bone, sort of like you would check the number of rings on a tree or the age of an iceberg, you stick that needle in there and take it out, we’re not able to numb the inside of the bone marrow. And that’s when pain happens. Usually, I think the best thing is to warn the patient when the pain is coming and to count down.
And, hopefully, it should never be longer than about six seconds worth of pain, six to eight seconds worth of pain, if you use adequate numbing medicines, and if you prepare the patient. Occasionally, you’ll hit a nerve that overlies the bone marrow. And that can send a jolting shock-like sensation down the leg. But that should never be permanent damage. That’s, typically, just because that nerve is hit by the needle going in.
That would have been very helpful.