doctor to take additional steps to minimize the discomfort, such as
taking the time to thoroughly anesthetize
best to avoid blood thinners prior to having a surgical
procedures, such as aspirin, fish oil, Vitamin E.
Talk to your doctor about medications and supplements you are taking.
About Fear of Bone Marrow Biopsies:
" I haven’t had one for almost a year. Before that I had had many, maybe 15 or so. They started out easy to take and progressively got worse to take. I am now TERRIFIED of them to the point where I hyperventilate and almost pass out.
That day the answers came pouring onto the list
(BMT-Talk) from around the world and were still coming four days later. Others were posted privately to the man who had become terrified of bone marrow biopsies. Here are a few:
“Have you tried Versed? The best BMB I ever had was from my local
hem/onc, who used
Versed—I was kind of awake but felt & remembered nothing.”
“I second the vote for the Versed (with a little Demerol thrown in…).”
“…IV Diazepam is the intended drug. A short and mercifully deep sedation without actual anesthesia—and usually amnesia about the actual event. You really deserve this after excruciating
“Two Vicodans plus Atavin. I can’t say it didn’t hurt but it wasn’t nearly as bad as I thought it would be.”
Tony writes: I'm one of those folks who doesn't like to be awake for his BMB. My first
one, just after being diagnosed, was fairly uncomfortable. Okay, it was
damn uncomfortable and hurt quite a bit. I had it done at my local hospital. My second one was done at Mayo for the Genitope trial. They put me out for
that one to harvest a node, and at the same time did the BMB.
My third BMB was needed for the Favrille trial in Chicago. I was able to
get that done at my local hospital but told my doc I refused to have it done
without some meds. I got some Vicodin to take an hour or so before the
procedure, and I got 2 ml of Ativan by IV just before the procedure. Yeah
that was sweet. Didn't feel a thing and did not remember a thing.
BMB number 4 was needed for my current trial. Again wanted some meds. This
time just got Versad by IV and it worked great! Didn't feel a thing. Of
course it's more involved when you get the meds by IV and you need to have
someone to drive you home after. But for me it's worth it.
On the other hand, a few years back my 87 year old mom needed a BMB a few
months before she died. I didn't say anything to her about my experience
because I didn't want to worry her. After it was over I asked her how bad
it was. She said it didn't hurt at all.
So, there's two opposing viewpoints.
~ Tony (Lymphomavaccine support list)
of the Bone Marrow Biopsy procedure
Discuss use of blood thinning supplements or
medications prior to the procedure. (See sidebar note.)
Discuss in advance the use of sedatives to
relieve anxiety and discomfort. See Questions About
Fear of BMB in sidebar.
The patient is usually placed on the side or lies
flat on the stomach.
An area above the buttocks near the pelvic bone
The physician can significantly reduce the discomfort in most
cases by taking the time to properly anesthetize the area.
The marrow is recovered from this region using a
bone marrow biopsy needle.
There are two basic types of samples. Considering the possible
discomfort and anxiety associated with bone marrow exams, it's
best to get both kinds with each test to avoid having to be stuck
- liquid from marrow - gets a count of the cells, the cell
lines present and and percentages of each.
or core sample - tells about the architecture of
the bone marrow, and how the cells may be interacting.
"Is there fibrosis? Is there scarring? Is there the
presence of different other kinds of diseases or processes
going on?" - HealthTalk
Pressure is applied to the biopsy site to stop
bleeding, and a bandage is applied.
Why do you
have to have so many bone marrow biopsies?
I had one 3-1/2
years ago. When I asked about having another one, neither of my
thought it was necessary.
Some Reasons for Bone Marrow Biopsies (BMB)
diagnosis of indolent lymphoma:
Your doctor might recommend a baseline bone marrow biopsy to
see if abnormal lymphoma cells are present there and in what
percentage. The findings might help to determine how
closely to monitor the lymphoma and perhaps the preferred treatment
BMB to monitor
indolent lymphoma: Ask your doctor if a BMB might not be
indicated (given the
discomfort and stress and expense) unless the findings will
influence the timing or approach to treatment. If you have no
symptoms and your managing the disease, why look for it?
results: Your doctor might order a BMB if unusual or
unexpected blood counts or markers are found that indicate disease
progression in the marrow or abnormal blood cell generation.
BMB for monitoring response to treatment for
aggressive lymphoma: We would think a
BMB is indicated in this setting as the goal of treatment is cure and
you have to be able to confirm (as best you can) you've got it all.
BMB and clinical trials:
Some (but certainly not all) clinical trials may require a
BMB before and after therapy to determine if the
treatment has benefit in this region.
that require prior BMB: Zevalin and Bexxar
require a BMB in advance of the therapy as too much involvement (> 25%)
can make you ineligible for this type of treatment.
(Pretreatment with standard therapy might be needed to change your
Question: Can imaging be used to detect bone
marrow involvement - or where to take the sample?
The practice of guiding bone marrow biopsies by
imaging is not routine for lymphomas at this time. We are still
searching for reports on this question.
Magnetic Resonance Imaging of Bone Marrow Versus
Bone Marrow Biopsy in Malignant Lymphoma Abstract
Detection of Lymphoma in Bone Marrow by Whole-Body
Positron Emission Tomography - bloodjournal
Bone Marrow Biopsy Needles and Procedures to Minimize Pain?
"Recently, specimen capturing bone marrow biopsy needles have
been introduced to minimize the pain resulting from manipulations of
the bone marrow needle and to help your doctor ensure recovery of
The SNARECOIL TM bone marrow biopsy needle is a specimen capturing
needle that incorporates a tiny internal snare mechanism that coils
around the tip of the specimen after it has entered the needle and
thereby captures it.
This mechanism eliminates the need to significantly move the needle
after it has been advanced into the bone marrow tissue to sever and
recover the specimen. This advantage is relevant not only for the
patient who may require a single bone marrow biopsy for diagnosis but
especially for those patients with hematologic malignancies such as
leukemias or lymphomas who may require multiple procedures to evaluate
the efficacy of their treatments." - ranfac.com
NOTE: We are seeking to verify the claims made
Utility of fine-needle aspiration (FNA) as a diagnostic
technique in lymphoma. J Clin Oncol. 2004 Aug 1;22(15):3046-52. PMID:
"Conclusion Overall, FNA for lymphoma diagnosis is not
helpful, not cost effective, and in addition may misguide
BCL-2/ t(14;18) Gene Rearrangement,
Quantitative Real-Time PCR Questdiagnostics
"The t(14;18) translocation is characteristic of B-cell
lymphomas, occurring in up to 90% of follicular lymphomas. It
is also found in 20% to 30% of diffuse large B-cell lymphomas
PCR has an analytical sensitivity of 1 tumor cell in 100,000
What is PCR Testing? faseb.orgm
Randomized, placebo-controlled study of
outpatient premedication for bone marrow biopsy in adults with
lymphoma. Clin Lymphoma. 2000 Sep;1(2):154-7. PMID: 11707825 abstract
The significance of bone marrow involvement in
non-Hodgkin's lymphoma: the Eastern Cooperative Oncology Group
experience. J Clin Oncol. 1986 Oct;4(10):1462-9. PMID: 3531421
Bone marrow biopsy for the staging of
non-Hodgkin's lymphoma: bilateral or unilateral trephine biopsy?
Tumori. 1995 Nov-Dec;81(6):410-3. PMID: 8804465 PubMed
Imaging to detect bone marrow involvement?
Comparative diagnostic accuracy of magnetic resonance
imaging [MRI] and immunoscintigraphy
(An imaging procedure in which antibodies labeled with
radioactive substances are given to the person.
A picture is taken of sites in the body where the antibody
localizes.) for detection of bone marrow involvement in patients with malignant lymphoma.
J Clin Oncol. 1997 May;15(5):1754-60. PMID:
Bone marrow biopsy for the staging of non-Hodgkin's
lymphoma: bilateral or unilateral trephine biopsy?
Tumori. 1995 Nov-Dec;81(6):410-3. PMID:
8804465 | Related