Bone Marrow Test: Biopsy Needle, Procedure, Price, and Results

Bone marrow tests are diagnostic procedures to examine the soft, spongy tissue located in the centre of the bones, known as bone marrow. These tests help evaluate bone marrow disorders, blood disorders, and certain cancers like leukaemia, lymphoma, and multiple myeloma. They check if the bone marrow is making normal amounts of the following blood cells:

1. Red blood cells (the most common types of cell that carry oxygen to the body’s tissues)

2. White blood cells (fight against infections and protect the body from illnesses)

3. Platelets (help with blood clotting to prevent bleeding)

According to a study by Reena Nair et al. in 2016, the incidence of non-Hodgkin lymphoma in India is 2.9/100,000 for men and 1.5/100,000 for women. While the incidence rate of the disease is less than in other countries, the mortality rate is higher in India. This primarily happens due to a delay in diagnosis and treatment.

A bone marrow test provides in-depth insights into an individual’s bone marrow and blood cells. The doctor may recommend these tests when blood tests yield abnormal results or lack sufficient details. Bone marrow tests are conducted for several reasons, including: 

1. Diagnosing Bone and Blood Marrow Disorders: By examining the bone marrow, doctors can determine the cause of abnormal blood cell production. These tests help diagnose conditions like anaemia, lymphoma, multiple myeloma, leukaemia, and other disorders. 

2. Investigating Fever of an Unknown Region: Individuals may experience unexplained fever. These tests help diagnose the cause of this fever, such as an infection in the bone marrow. 

3. Determining the Stage of Cancers: These tests can help determine how much the cancer has progressed. They assess the spread of cancer to the bone marrow. 

4. Monitoring Treatment: A doctor may conduct bone marrow tests to assess the effectiveness of cancer treatment. The results reveal whether the bone marrow produces enough healthy blood cells following the treatment.

5. Preparing for a Bone Marrow Transplant: This test is conducted when an allogeneic bone marrow transplant (stem cells from a donor replace the damaged bone marrow) is required. To assess the suitability of the donor and recipient, as well as ensure a successful transplant.

Bone marrow tests play a vital role in determining the health of the bone marrow. It diagnoses, monitors, and treats various medical conditions, improving patient outcomes and healthcare. The following are the benefits of bone marrow examinations: 

1. Precisely diagnose various blood and bone marrow-related disorders

2. The results help guide treatment plans, including chemotherapy, radiation, or transplant

3. Allows ongoing monitoring to assess treatment effectiveness

4. Evaluates the compatibility of donor and recipient for bone marrow transplant 

There are primarily two types of bone marrow tests. Both these tests are generally performed together to provide a more comprehensive assessment of the bone marrow and its function. These types include: 

1. Bone Marrow Biopsy: The test involves removing a small sample of bone and bone marrow. 

2. Bone Marrow Aspiration: In this procedure, the doctor extracts a small sample of bone marrow fluids and cells. 

Preparing for a bone marrow biopsy and aspiration ensures the procedure goes smoothly and safely. Patients must follow the doctor’s specific instructions for preparation. Before a bone marrow test, individuals can expect the following: 

1. Fasting: If a sedative is used during the procedure, individuals must stop eating or drinking the night before the test. 

2. Medications: Patients must inform the doctor about their medications, vitamins, and supplements. The doctor may recommend temporarily discontinuing certain blood-thinning medications, which can increase the risk of bleeding after the bone marrow test. 

3. Transportation: The test may involve the use of sedatives or anaesthesia. Therefore, individuals must arrange for someone to drive them home after the test. 

4. Discussion: Patients must discuss any questions and concerns with their doctor about the procedure. 

Bone marrow examination is an outpatient procedure performed in a hospital. The bone marrow sample can be collected in about 10 to 20 minutes. The exact procedure depends on the doctor's advice and the type of test performed. Generally, a bone marrow test involves the following steps: 

1. Positioning: The patient will be asked to lie on their abdomen or side. This position helps doctors easily access the hipbone, where the bone marrow sample is usually taken. The patient’s body will be draped with a cloth, with only the examination site visible. 

2. IV Administration: The anaesthesiologist will insert an IV line in the patient’s arm for fluids and medications. The doctor may give an IV medication to the patient to partially or completely sedate them during the procedure. 

3. Anaesthesia Administration: The anaesthesiologist will administer local anaesthesia to numb the area where the needles are inserted. Patients may experience sharp pain during the procedure, especially aspiration. 

4. Cleaning and Marking Surgical Site: One nurse will clean the surgical area with an antiseptic to prevent infections. The doctor will mark the area where the bone marrow biopsy needle will be inserted. This is usually the back of the hipbone (posterior iliac crest). Rarely, bone marrow aspiration may be collected from the breastbone or lower leg bone for children under 12 to 18 months. 

5. Aspiration: This procedure is usually performed first. The doctor will make a small incision in the skin. They will insert a thin, hollow needle through the bone and into the bone marrow. A small amount of liquid bone marrow will be drawn into a syringe. Several samples may be collected for examination.

6. Biopsy: The doctor will perform a bone marrow biopsy procedure after aspiration. They will insert a larger needle to remove a tissue sample from solid bone marrow. The bone marrow biopsy needle has a hollowed-out centre to remove a core or cylindrical-shaped tissue sample. This is why bone marrow biopsy is also called core biopsy. 

7. Dressing and Recovery: After the procedure, the doctor will apply pressure and a bandage on the site to prevent bleeding. 

8. Observation: If the test is performed under local anaesthesia, patients will be asked to lie down for 10 to 15 minutes. They can leave and resume their normal routine. Those with IV sedation will be taken to a recovery area for observation. 

Please Note: The selection of the type of test is based on the patient’s condition and the doctor’s opinion. The collected bone marrow sample will be sent to a laboratory or diagnostic facility to be examined under a microscope. 

After a bone marrow biopsy test, it is important to follow instructions given by the doctor. It helps ensure a smooth recovery and minimises potential complications. The following are some general guidelines: 

1. Medications: Patients may experience pain or tenderness for a week after the test. The doctor will prescribe pain relief medications to manage pain and discomfort. 

2. Dressing Care: It is important to wear the bandage after the procedure as the doctor instructs. Patients should not bathe, shower, swim, or use a hot tub to keep the wound dry for at least 24 hours. They can wet the area after 24 hours.

3. Activity Restrictions: The doctor may recommend avoiding heavy lifting and rigorous activities for a day or two. This helps minimise bleeding and discomfort.

The results of the bone marrow test are available within one to three weeks. A haemotologist (doctor specialising in blood) or oncologist (doctor specialising in cancer) will analyse the reports. The test results can help doctors assess blood cell production and diagnose diseases. The results of a bone marrow test can be normal or abnormal. 

1. Normal Results: If the bone marrow tests show normal cell composition and development, the bone marrow is healthy and functioning properly. This rules out blood or bone marrow disorders.

2. Abnormal Results: Abnormalities in the cell count and composition may indicate disorders like cancer, infection, or bone marrow diseases. For abnormal results, the doctor may conduct more tests to confirm the diagnosis and select a treatment approach. 

Interpretation of Bone Marrow Test Results 

Interpreting bone marrow test results is a complex task that requires the expertise of a medical professional. The following are general guidelines for interpreting abnormal test results:

1. Cancer: The presence of cancer cells in the bone marrow confirms cancer diagnosis, including leukaemia, lymphoma, and myeloma. If the patient already has cancer, the test results can help determine the stage of cancer by determining whether it has spread to the bone marrow.  

2. Blood Cell Imbalances: Bone marrow test results enable doctors to evaluate if an individual has abnormal blood cell counts, either an excess or deficiency. Imbalances in blood cells can indicate various medical conditions.

Treatment following a bone marrow test depends on the specific diagnosis and the medical condition revealed by the test results. Here are some possible treatment options:

1. Blood Transfusions: In cases of bone marrow failure, the doctor may recommend blood transfusions to increase red blood cells and platelets. It helps relieve symptoms like anaemia, bleeding, and fatigue. 

2. Medications: Corticosteroids (anti-inflammatory medicine) and androgens (male hormones) help increase blood cell production in case of bone marrow failure. 

3. Chemotherapy: The treatment includes drugs to locate and destroy cancerous cells in the body. It may be recommended for conditions like leukaemia or lymphoma. 

4. Radiation Therapy: It delivers high-energy beams to a targeted area to kill cancer cells or reduce tumour size. It may be recommended for cancers like lymphoma, where malignant cells are detected in the bone marrow. 

5. Targeted Therapy: It uses drugs to attack specific cancer cells. As opposed to chemotherapy, targeted therapy prevents damage to healthy cells. 

6. Bone Marrow Transplant: In certain cases, a bone marrow transplant (stem cell transplant) may be necessary. It is especially performed for leukaemia, myeloma, or bone marrow failure.

Please note that the treatment will be tailored to the patient’s condition and diagnosis.

Bone marrow tests are generally safe procedures. However, like any medical intervention, they carry potential risks and complications. It is important to be aware of these risks, even though they are relatively rare. Possible risks and complications associated with bone marrow tests include:

1. Pain or Discomfort: Many patients experience pain, discomfort, or tenderness at the biopsy site after the procedure. It is generally mild, and patients can manage it with pain relievers.

2. Scarring: Bone marrow biopsy scar is a common consequence of the procedure resulting from the insertion of a biopsy needle. However, it is generally minimal and not a significant concern. 

3. Redness, Swelling, Bleeding, or Fluid Leakage: It is common to experience minor bruising or bleeding at the biopsy site. However, increased redness, swelling, and bleeding indicate complications like infection or inadequate wound healing.

4. Fever: If patients develop a fever after a bone marrow test, it may indicate an infection. It may occur with other signs of infections like localised warmth, pain, and tenderness at the biopsy site. 

When to Consult a Doctor? 

Communication with a doctor is essential to address potential complications and ensure a safe and effective recovery. Patients should consult a doctor after bone marrow tests if they experience any concerning symptoms or complications, including:

1. Uncontrolled bleeding that soaks the bandage or persists despite applying pressure

2. A persistent fever

3. Increased pain or discomfort at the biopsy site

4. Redness, swelling, or unusual discharge from the procedure site 

Individuals should understand the bone marrow test price before undergoing the procedure. The cost can differ between a bone marrow biopsy and aspiration. Generally, the cost of bone marrow tests in India starts from ₹4,000. The average price of the test is ₹7,000, which can go up to ₹ 20,000. 

The bone marrow test price can vary depending on several factors. These factors include: 

1. Hospital or Clinic: The choice of hospital can significantly impact the cost. Private hospitals generally are more expensive than government hospitals or non-profit institutions.

2. Location: The city or region where the test is conducted can affect prices. Metropolitan areas often have higher costs.

3. Doctor’s Fee: The fee charged by the doctor or specialist performing the test. Highly skilled and experienced doctors may charge more. 

4. Type of Test: Different types of bone marrow tests have varying costs. Bone marrow biopsy cost can differ from that of aspiration. 

5. Diagnostic Facility: The laboratory where the bone marrow sample is analysed can influence the cost. The cost depends on the facility’s location, equipment, and reputation. 

Bone marrow tests are diagnostic procedures that offer vital information about several medical conditions. These tests aid in early diagnosis and precise treatment planning. They also help monitor the progress of disorders affecting the bone marrow and blood. With advancements in medical technology, bone marrow tests continue to enhance patient outcomes and quality of care.

If you or your loved ones are looking to undergo bone marrow biopsy and aspiration, consult the experts at HexaHealth today! Our expert team will help you at each step throughout the procedure. We can connect you with the top hospitals and doctors for further treatment and intervention.  

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