Bone Marrow Biopsy

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Good afternoon,

I am not sure if this is acceptable to post on here or not. If not please remove. I have drafted this following my own painful biopsy so that in future, should I need a second, I can refer to this so I can discuss with my Consultant and the person performing the biopsy.

Bone Marrow Biopsy – Patient Request Note

I previously had a bone marrow biopsy/aspirate that was extremely painful, particularly during the aspiration and the injection onto the bone surface. I would be very grateful if the following could be considered to improve comfort during any future procedure:

1. Pain control / sedation

  • I would like to discuss the option of sedation (oral or IV) in addition to local anesthetic (e.g. lidocaine).

2. Local anesthetic technique

  • Please inject the anesthetic slowly and in stages, including careful numbing of the bone surface (periosteum).

  • If possible, allow adequate time for the anesthetic to take effect before proceeding.

3. Aspirate technique

  • I would prefer one short, quick aspirate attempt if feasible.

  • If the aspirate appears difficult or very painful, I would be happy for the procedure to rely on the core biopsy instead.

4. Limiting discomfort

  • If pain becomes severe or continuous, I would like to request that the aspirate be stopped. Agree a stop sign - ie raised hand.

5. Operator and communication

  • If possible, I would prefer an experienced operator.

  • Please let me know just before key steps (especially aspiration), and give me a few moments so I can prepare.

Thank you for taking this into account. I appreciate your help in making the procedure as comfortable as possible.

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Hi @meljarv

Not aware that there would be any reason to not share what you have and it all appears reasonable from my non medical perspective.

One technique you may want to try is framing what you would like to happen as a request or series of requests.

Hope that helps

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I suspect the key point is point 5. I’ve only had 1 bone marrow biopsy with 2 insertion and it was virtually painless with no real discomfort when I got home either. I’m sedation was key with 2 separate injections, one in the general area, the other in the bone. That last one was slightly painful but must have been effective for the main procedure.

I’m sorry you had a bad experience and I think its good to lay down what you have done for the next time.

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Thank you.

My aspirate was difficult, all I ended up giving was an extremely painful blood sample! I also had to have 2 bone biopsies as he made a mess of the first.

I am not medical but I have read that when they do the deeper infiltration injection too quickly, that can be painful. That’s why I have said slowly at point 2.

Mel

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Hi Duncan B,

How are you getting on?

I am in a much better place now. I did think to frame my requests as you said but if there is a next time I want to feel more in control.

I ended up only giving a blood sample! No marrow aspirated. I had to have 2 bone biopsies as he made a mess of the first.

All the best

Mel

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Hi @meljarv

I’m doing well at present thank you.

Not sure if it’s your first bone marrow biopsy.

I remember the first one being the most challenging but definitely better after that. Pretty sure it took a few attempts to get the trephine sample. The Nurse Practitioner who did it very experienced.

Think that if they massage the area they are taking sample from it definitely helps.

Take care

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Hi @meljarv please don’t worry, you’re welcome to share this here. You’re not offering anyone else medical advice.

I hope it gives you more confidence going into any future procedure (I know I would have loved something like this in my bone marrow biopsies). Our information on bone marrow biopsies might also be worth a look if you haven’t come across it - it confirms that pain does vary considerably from person to person, and that sedation and gas and air are options worth discussing with your team in advance.

Take care,

Ceri - Blood Cancer UK Support Services

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Hi DuncanB,

I just wanted to let you know that I have been working on a standard operating procedure for bone marrow biopsies. I handed it to my Consultant yesterday and he seemed genuinely impressed with it. I included a section on pain management and included deep breathing as you mentioned that this really helped you during your many BMBs. So if you have to have another BMB, which I hope you don’t, and the support workers mention breathing deeply, just know you have made a difference and your advice is helping others.

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Thanks @meljarv

What you have done with the protocol that you’ve shared with your Consultant sounds fantastic.

The Deep Breathing tip I mentioned actually came from the Advanced Nurse Practitioner at Raigmore Hospital who does the Bone Marrow Biopsies

I’ve had about 10 Bone Marrow Biopsies since first diagnosed and if I don’t need anymore soon that’s a positive sign

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Hi DuncanB,

I hope that tip about deep breathing helps others.

Hopefully neither of us will have to go through another bone marrow biopsy again.

Just thought I would mention, I obtained a copy of my medical records from the hospital. One record mentioned that I had mild fibrosis. After much research I have found out that fibrosis makes bone marrow sticky so an aspiration was always going to be painful, they wouldn’t have known that before the biopsy. Blood will then flow better than marrow and it’s one of the reasons why there was only blood; the samples were dilute. There was not enough marrow for the lab to assess. That’s why my note says one quick put because an experienced operator would know instantly if only blood was being aspirated. They assessed my results from the bone samples as there is marrow between the layers of bone. I am finding it all very interesting.

I put one report (it was only about a page long) through chat gbt, that was a revelation, it didn’t diagnose my condition but it gave me an insight in to what the tests are for and more of the why and what they are looking for.

Best wishes

Mel

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Sounds like you have enjoyed doing some research @meljarv

Enjoy your weekend