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Bone marrow test

You may have this test to find out more information about the acute lymphoblastic leukamia (ALL). Bone marrow is spongy tissue and fluid that is inside some of your bones. It makes blood cells.

A doctor or specialist nurse removes an area of bone marrow from your hip bone. A specialist doctor looks at the tissue under a microscope. 

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You usually have the test in the outpatient department of the hospital. You are awake for the test but you have a local anaesthetic to numb the area.

Some people may have medicine to make them drowsy (sedation). Some hospitals may use gas and air (Entonox) to help relax you instead of sedation. 

Types of biopsy

There are 2 main types of bone marrow test: 

  • bone marrow aspiration
  • bone marrow trephine biopsy

Aspiration means the doctor or nurse sucks some liquid bone marrow up into a syringe.

A bone marrow trephine means that they remove a 1 or 2cm core of bone marrow in one piece.

You usually have both of these tests done at the same time. They give some of the same information to the doctor, but there are differences. The bone marrow trephine shows the structure of the bone marrow inside the bone, whereas the aspiration takes just the bone marrow cells.

Preparing for your bone marrow test

Your nurse or doctor will tell you how to prepare for the bone marrow test if you are in hospital. If you are an outpatient your appointment letter will explain what you need to do.

You are usually able to eat and drink beforehand if you aren't having sedation.

Take your medicines as normal unless told otherwise. If you are taking any blood thinning medicines, you might need to stop these before the test. Your doctor will tell you when to stop taking them.

What happens?

Your doctor gives you information about the procedure and asks you to sign a consent form. This is a good time to ask any questions you have.

You change into a hospital gown and lie on your side with your knees tucked up into your chest.

Your doctor or nurse cleans the area with some antiseptic fluid, which can feel cold. You then have an injection into the skin over the biopsy site to numb the area. They put a thin needle through the skin into the hip bone. This might be uncomfortable but this only lasts a short time. 

Your doctor or nurse sucks a small amount of liquid bone marrow into the needle, using a syringe. You feel a pulling sensation when they start drawing the bone marrow cells out. 

They take the needle out and put in a second one if you're having a trephine biopsy as well. The aim is to get a small amount of marrow out in one piece.

The whole test takes around 30 minutes.

After your bone marrow test

If you have sedation, you need to stay at the hospital for a few hours until it has worn off. And you need someone to take you home and stay with you overnight.

You usually go home the same day if you're feeling well enough.

You have a dressing over the site, which you should keep on for 24 hours. 

Possible risks from bone marrow test

A bone marrow test is very safe and any risks are small. 

During the procedure there is a very small risk of damage to nearby structures, but this is very rare.  

Bleeding

It's not unusual to have a small amount of bleeding from the area where the needle went in. If you notice any heavy bleeding, apply pressure to the area. If it doesn't stop, contact the hospital.

Bruising

Sometimes blood leaks out of the vein and collects under your skin. This can look like a small dark swelling under the skin (haematoma). Pressing hard once the needle is removed can help

Infection

There is a small risk of getting an infection in the wound. Tell your doctor if you have a temperature or if the area becomes red and sore. 

Pain

Some people feel uncomfortable and have pain after the local anaesthetic has worn off. Your nurse will tell you what painkillers to take. If you have severe pain or it's getting worse then you should contact the hospital.

Tingling in your leg

You may have some tingling in your leg which wears off with time.

Getting your results

You should get your results within 1 or 2 weeks at a follow up appointment.

Waiting for test results can be a worrying time. You can contact your specialist nurse if you’re finding it hard to cope. It can also help to talk to a close friend or relative about how you feel.

For support and information, you can call the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.

Contact the doctor that arranged the test if you haven't heard anything after a couple of weeks.

DNA analysis

Other laboratory tests may be carried out on the blood or bone marrow cells you've given. These tests are called chromosome analysis. Your haematologist may order these tests to look for changes (abnormalities) in your chromosomes. The tests are also called cytogenetic tests or molecular analysis.

Philadelphia chromosome

Some people with ALL have a change in the leukaemia cells called the Philadelphia chromosome. This is called Philadelphia positive ALL. This is when a gene called the ABL1 gene on chromosome 9 breaks off and sticks to a gene called the BCR gene on chromosome 22. It produces a new gene called BCR-ABL1. This gene causes the cell to make too much of a protein called tyrosine kinase. This protein encourages leukaemia cells to grow and multiply.

Watch this 2 minute video to explain what Philadelphia positive leukaemia is. 

FISH (fluorescence in situ hybridisation)

FISH is a test that looks for gene changes in cells. It can help the specialist to work out which treatment you need. 

Tests during treatment

Minimal residual disease (MRD)

You also have bone marrow tests during treatment. This is to check how well your chemotherapy has worked and whether your leukaemia is likely to come back. 

A small number of leukaemia cells can be left behind after treatment. This is called minimal residual disease (MRD).

There are two techniques for finding MRD:

  • polymerase chain reaction - looking for genetic changes in cells
  • immunophenotyping - looking for certain proteins made by leukaemia cells
Last reviewed: 
30 Apr 2018
  • Acute lymphoblastic leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up
    D Hoezler and others
    Annals of Oncology, 2016. Volume 27, Supplement 5, Pages 69-82

  • Hoffbrand’s Essential Haematology (7th Edition)
    AV Hoffbrand and PAH Moss
    Wiley Blackwell, 2016

  • Cancer and its management (7th edition)
    J Tobias and D Hochhauser
    Wiley-Blackwell, 2015

  • Fluorescence In situ Hybridization: Cell-Based Genetic Diagnostic and Research Applications
    C Cui and others
    Frontiers in Cell and Developmental Biology, 2016. Volume 4, Issue 89

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