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Painful or necessary? The real experience during bone marrow examination revealed!
A bone marrow examination is a procedure to obtain a sample of bone marrow for pathological analysis through a bone marrow biopsy (often called a cylinder biopsy) and a bone marrow aspiration. This test is used to diagnose a variety of disorders, including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia. Bone marrow is essential for the production of blood cells, including platelets, red blood cells, and white blood cells.
While a blood draw from a vein can provide a lot of information, sometimes it is necessary to examine the bone marrow to obtain more information about blood production.
Components of the Inspection Process
Bone marrow samples can be obtained through aspiration and cylinder biopsy. Sometimes a bone marrow test will include both an aspiration and a biopsy. The aspiration yields a semifluid volume of bone marrow, which can be examined by a pathologist under a light microscope and analyzed by flow cytometry, chromosome analysis, or polymerase chain reaction (PCR). A cylindrical biopsy is also commonly done, which obtains a narrow, cylindrical sample of solid bone marrow, about 2 millimeters wide and 2 centimeters long.
Using a 20 ml syringe, approximately 300 microliters of bone marrow sample can be obtained in one extraction. If the sample exceeds 300 μl, there is a risk of dilution of the peripheral blood in the sample.
Where the procedure is carried out
Bone marrow aspiration and cylindrical biopsy are usually done from the back of the hip bone or over the posterior iliac ridge. The sternum can also be used for extraction. For sternal extraction, the patient lies supine with a pillow placed under the shoulders to elevate the chest. Cylindrical biopsies above the sternum should be avoided because of the risk of injury to the vessels, lungs, or heart. For children younger than 2 years old, a bone marrow aspiration may also be done from the tibia (lower leg).
To reduce the superficial pain caused by the needle, an anesthetic is used. However, since the bone marrow cannot be anesthetized, you may feel pain during the examination.
Execution of inspection
A bone marrow biopsy can be done in a healthcare provider's office or in a hospital. Informed consent for the procedure is usually required. The patient lies on his or her stomach (prone) or side, the skin is cleaned, and a local anesthetic is usually given with lidocaine or procaine. Patients may also be pre-treated with analgesics or anti-anxiety medications, although this is not routine practice.
The entire process usually takes about 10 to 15 minutes after preparation is complete.
Contraindications and complications of examination
There are very few contraindications to bone marrow examination, notably thrombocytopenia (or bleeding disorders) as long as it is performed by an experienced clinician. Although there may be mild pain for 12–24 hours after surgery, serious complications are extremely rare. In a review of hundreds of thousands of bone marrow examinations, the incidence of serious adverse events was 0.05%. In most cases, a common complication is bleeding.
Although complications are very rare in the report, the seriousness of the case cannot be ignored.
Real patient experience
Many patients who underwent bone marrow tests shared their experiences, some saying that the discomfort during the test was within their expectations and that not every patient experienced the same pain at the same time. Although most people can tolerate it, some people may experience a certain degree of pain or discomfort afterwards, but the necessity of the examination often makes patients feel that it is all worth it.
ConclusionIn evaluating whether a bone marrow examination is necessary, patients should consider not only the potential for pain but also the health information that the examination will reveal. Is it possible to accept discomfort in the process in order to gain deeper understanding?
