Bone Marrow Sampling

Bone Marrow Sampling

Haematology Department

Investigative procedure information leaflet

It has been recommended that you have a bone marrow sample taken. Your bone
marrow is the spongy tissue and fluid which is found inside some of the larger bones in
your body, such as your pelvis or chest bone. The bone marrow makes your red blood
cells, white blood cells, and platelets.

There are a number of reasons why you will have been advised to have this test. These
include;

• To find the cause of abnormal blood counts
• To determine the presence of a disease
• To monitor treatment response.

A bone marrow aspirate involves using a special needle and syringe to remove some
of your bone marrow fluid which is then examined in the laboratory.

A bone marrow (trephine) biopsy is when a small core of the bone marrow tissue is
removed in one piece. The sample of tissue will be examined under a microscope to
look for abnormal cells.

This leaflet explains some of the benefits, risks and alternatives to the operation. We
want you to have an informed choice so you can make the right decision. Please ask
your medical team about anything you do not fully understand or want to be explained
in more detail.

We recommend that you read this leaflet carefully. You and your doctor (or other
appropriate health professional) will also need to record that you agree to have the
procedure by signing a consent form, which your health professional will give you.

Bone Marrow and Clinical Research
In Worcestershire Acute Hospitals NHS Trust we have a number of haematology clinical
trials running at any one time. These are all ethically approved research studies. When
you have your bone marrow test done we may ask your permission to store some of the
excess tissue or take some extra tissue to be stored for potential research in the future.
By taking research samples or storing excess tissue at the time of your diagnostic bone
marrow test, it may avoid the need for another bone marrow test if you were offered
participation in a trial later on.

You may also be given an information sheet and consent form for the Central England
Haemato-oncology Biobank. The Biobank is not included in the type of consent
described above and needs Biobank specific consent. The Biobank stores bone marrow
and blood samples, consent includes samples previously sent to Birmingham Women’s
Hospital, as well as any future samples.

Benefits of the procedure
The aim of the procedure is to detect disease and monitor progress of your treatment.

Serious or frequent risks
Everything we do in life has risks. A bone marrow procedure is considered to be safe,
but occasionally there can be side effects and complications. These can include:

Bleeding
In a small number of cases there is some bleeding from the biopsy site. This
usually stops by itself. Very rarely the bleeding is more severe and may require
a blood transfusion.

Infection
There is a very small risk that the small wound will become infected.

Damage to nearby structures
Rarely the needle damages other nearby structures (for example, nerves and
muscles).

You will be cared for by a skilled team of doctors, nurses and other healthcare workers
who are involved in this type of procedure every day. If problems arise, we will be able
to assess them and deal with them appropriately.

Other procedures that are available
At present there are no other alternatives to this recommended procedure.

Preparation before your procedure
You may need a blood test shortly before the bone barrow procedure to check how well
your blood will clot. This is to make sure that you are not likely to bleed too much from
the biopsy site.

Tell your doctor or nurse if you have previously had an allergic reaction to any local
anaesthetics. You may continue to eat and drink as normal before your procedure.

Your normal medicines
Continue to take your normal medicines up to and including the day of your procedure.
If we do not want you to take your normal medication, your doctor or nurse will explain
what you should do. It is important to let us know if you are taking anticoagulant drugs
(for example, warfarin, clopidogrel or aspirin).

Your anaesthetic
The procedure is usually carried out using a local anaesthetic – this will numb the area
of skin around the biopsy site.

During your investigation
You will usually be asked to lie on a couch on your side in a comfortable position with
your knees curled up.

Once the area of skin has been cleaned with antiseptic, local anaesthetic is then injected
into a small area of skin and tissues just over the chosen area of bone. The anaesthetic
stings a little at first but then makes your skin go numb. The needle used to sample your
bone marrow is then inserted and the sample is taken, using a syringe attached to a
needle. The needle is then removed. If a bone marrow (trephine) biopsy is required as
well, a slightly different type of hollow needle is then inserted into the bone, through the
area of anaesthetised skin, which retains a core or marrow inside it when it is removed.

Bone marrow samples are usually taken from the back of the pelvic bone (the bony part
that you easily feel just below your waist). Occasionally they are taken from the breast
bone.

Once complete the needle is taken out and a plaster is put over the site of needle entry.

You may be offered the opportunity to have the biopsy performed using needles
attached to an electric drill. Please discuss this with the nurse or Doctor if you have a
preference.

After your investigation
You will be asked to lie down and rest for a short time after the procedure to make sure
that there is no excessive bleeding.

You may have some discomfort and bruising over the test site for a few days, which you
can ease with painkillers such as paracetamol.

Leaving hospital
Once you get home, it is important to rest quietly for the rest of the day. This is very
important if you have had sedation. Sedation lasts longer than you may think it would.

If you have had sedation, for 24 hours after the procedure, you should not:

• be left on your own;
• drive a car;
• sign any legally binding documents;
• take sleeping tablets;
• work at heights – including ladders;
• use machinery; or
• drink alcohol.

The effects of any sedation, anaesthetic and the procedure itself should have worn off
by the next day, when most patients are able to start normal activities again.

Contact details
If you have any specific concerns that you feel have not been answered and need
explaining, please contact the following.

Garden Suite, Alexandra Hospital (phone 01527 512092)
Millbrook Suite, Kidderminster Hospital (phone 01562 513093)
Clinical Nurse Specialist, Redditch (phone 07771982762)
Clinical Nurse Specialist, Worcester (phone 01905 760695 or 01905 763333 and
ask switchboard to page bleep no 357)
Laurel 3 (Haematology Inpatient Unit at Worcester) (phone 01905 760568)

Other information
Do not forget advice, encouragement and support from staff is always available.

We have addresses and telephone numbers for support groups, and other useful
booklets and information.

The following internet websites contain information that you may find useful.
www.worcsacute.nhs.uk
Information about Worcestershire Acute Hospitals NHS Trust
www.macmillan.org.uk
Booklets on specific cancers and practical guides to living with cancer
www.patient.co.uk
Information fact sheets on health and disease.
www.nhsdirect.nhs.uk
On-line Health Encyclopaedia and Best Treatments Website.

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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