Bone marrow biopsy

Bone marrow biopsy is a technique to remove a small section of the tissue from the body to study it under the microscope for any further analysis and tests. This test is recommended by doctors if they see an abnormal result in the complete blood count of a person or for examining any other regular disease that might be present in the bone marrow. Bone marrow biopsies are used to check for blood disorders like leukemia, certain types of anemia or problems affecting the bone marrow such as multiple myeloma or polycythemia vera. Besides they can throw light on any infections or cancers that are originating in the bone marrow. A bone marrow biopsy aids in studying abnormal appearance and numbers of red blood cells, white blood cells or platelets in conditions such as thrombocytopenia. It is essential to keep the health care provider of any medications that are taken. A local anesthetic is usually given to numb the skin. A sedative may be prescribed to calm the patient throughout the bone marrow biopsy procedure.

• Samples are usually taken from the hip bone after cleaning the area.
  
• A biopsy needle is inserted into the bone.
  
• Core of the needle is removed and the needle is turned in both the directions thus forcing a small sample of the bone marrow into the needle.
  
• The needle is removed from the site and pressure is applied on that area to restrict bleeding and the area is bandaged.
  
• There might some discomfort after the biopsy needle is removed as the anesthesia effect cannot reach the bone interiors.
  
• Bone marrow biopsy will take about 20 minutes and after the biopsy you may be asked to lie down for another 60 minutes to check for bleeding from the site.

Results of bone marrow biopsies are available after 1 to 3 days. Normal results are indicated by normal numbers of mature and growing bone marrow cells. Abnormal results of a bone marrow biopsy are indicated by abnormal appearance of normal numbers of mature and growing bone marrow cells and presence of fibrous tissue in the bone marrow. There may be special stains that confirm infection in the bone marrow.

Bone biopsy

Bone biopsy is a medical procedure during which a small sample of bone tissue is taken and examined for the presence of cancer cells, infections or any other bone disorders. Bone biopsy involves removing the hard outer portion of the bone from the compact tissue, unlike bone marrow biopsy procedure where the innermost sponge-like material containing marrow is removed to assess for abnormalities.

Why is bone biopsy conducted?

Tests like x rays and bone scans may reveal a tumor, but whether it is benign or malignant and if it is malignant, the type of cancer cell is detected accurately by bone biopsy. Bone biopsy determines the presence of benign tumors like Fibroma, Osteoblastoma, Osteoid osteoma and cysts and cancerous tumors like Ewing's sarcoma, Multiple myeloma and Osteosarcoma. Apart from tumors, bone biopsies are also used to identify the bone infections like osteomyelitis and abnormal bone structures that may be causing persistent pain and tenderness.

Types of bone biopsy

Closed biopsy or needle biopsy involves inserting a needle through the skin into the bone to draw a small bone tissue with the needle. Closed biopsy is performed under imaging guidance using a variety of modalities such as fluoroscopy, CT and MRI. Firstly the doctor will choose the bone, mostly the one that is closer to the surface such as hip bone, but biopsy can be performed on any bone. The area is sterilized with antiseptic lotion and local anesthesia is administered. It is important for the patient to remain motionless during the procedure; he may be strapped or belted to restrict movement.

A small incision is made at the site through which the needle is drilled till it finds bone. Needle will be wriggled into the bone to obtain the sample. After the needle is withdrawn, gentle pressure is applied on the site to control the bleeding; finally, the area is cleaned and covered with the bandage. The tissue sample is sent to the laboratory for analysis.

Open biopsy procedure takes place during surgery after administering general anesthesia. Here, the size of the incision is relatively larger as a small piece of bone is removed from the patient's body for further examination.

The patient is required to undergo few blood tests before the procedure to assess the blood clotting and the functioning of kidneys and liver. Medications like blood thinners and anti platelet drugs may need to be stopped temporarily. The site of the biopsy may feel sore and tender for few days and patient may be given pain relievers. If it is a closed biopsy, the patient can return home within an hour or as soon as he starts feeling comfortable. In the case of open biopsy, the patient will regain consciousness after few minutes but may feel drowsy for few hours after the procedure and is retained in the hospital for the whole day. Whether it is needle or open biopsy, patient should keep the area of biopsy bandaged and dry to avoid infections.

Complications arising from bone biopsy are rare, yet patient should be aware of the risks associated with the bone biopsy. Patient may contact skin infection or suffer from bone infection. There is also a risk of needle breaking the bone and causing injury. Hence whenever there is bleeding, redness or oozing of the pus or fever, pain and chills, it should immediately be brought to the doctor's notice.

Leukemia

Leukemia is cancer of the white blood cells found in the blood. This serious disease is often fatal. Leukemia is caused due to either of the 2 abnormal white blood cells:

• Myeloid white blood cells are made in the bone marrow from where they travel through the bloodstream destroying foreign organisms.
  
• Lymphoid white blood cells are located in the lymph nodes and lymphatic system.
  Chronic leukemia is a situation where the disease progresses slowly. Acute leukemia is indicated by a sudden onset and is more likely to affect children and young people.

A person suffering from leukemia noticed repeated infections and unexplained bruising. There is a tendency to feel fatigued and anemic. Other symptoms include loss of weight and fever. Aching joints and bones are yet another symptom of leukemia. Symptoms of acute lymphoblastic leukemia appear very rapidly. A detailed blood test is taken for diagnosing leukemia. When it shows an abnormal number of abnormal white blood cells, it is indicative of leukemia. A bone marrow biopsy is taken to help classify the leukemia.

Treatment for leukemia includes radiotherapy, chemotherapy, immune therapy and bone marrow transplantation. Chemotherapy treatment uses cytotoxic drugs to kill abnormal cells thereby stopping their further division. But the fallout of this procedure is that often normal body cells such as those in the hair and skin are also killed. Bone marrow transplant is carried out only on children and younger patients. Marrow cells from a donor, who is generally a sibling, is replaced in the patient.