Patient Information
Referral to a Hematologist
The process of being referred to a Hematologist and undergoing a bone marrow biopsy procedure may generate additional questions and concerns for the referred patient and family. A short summary is provided below to help patients and their families better understand the process and their interaction with the blood specialist.
The Hematology Consultation
A patient generally is referred to a Hematologist for evaluation of unexplained anemias or abnormalities of the white blood counts and platelets or for possible hematologic malignancies such as lymphomas. Some blood abnormalities can be easily explained by simple blood tests. For example, an analysis of the blood can document decreases of iron in patients with iron deficiency anemia or decreases of the B12 levels in pernicious anemia. However, many anemias and abnormalities of the white blood cells or platelets require more definitive analysis to determine the cause of the problem. Examination of the blood forming tissue or the bone marrow provides the most direct test to analyze the production of the white blood cells, red blood cells and platelets or involvement of the bone marrow with leukemia, lymphomas or multiple myeloma. In many situations a diagnosis can only be established by obtaining a bone marrow specimen for analysis. Your doctor may therefore recommend a bone marrow examination to help explain or characterize abnormalities of the blood or lymph nodes.
Bone Marrow Specimens
Both a solid cylindrical specimen of bone marrow and a fluid liquid specimen can be obtained by your doctor for analysis. Each specimen provides certain information to help your physician understand the blood abnormality. The solid cored specimen is prepared by the pathologist for examination under the microscope. It allows the pathologist to determine if normal or abnormal numbers and types of bone marrow cells are present. Also the pathologist can determine if diseases such as leukemia, lymphoma, myeloma or cancer are infiltrating the bone marrow. The fluid material is used to make slides for microscopic examination that provide a more detailed view of the bone marrow cells. The liquid bone marrow also may be used to study the proteins on the surface of the blood cells and the chromosomes of the bone
marrow cells. These studies help identify abnormalities which are characteristic of certain blood diseases. Your doctor may be able to provide a definitive diagnosis which explains the blood abnormality after careful analysis of the bone marrow specimen. Appropriate treatment can then be recommended. Generally, the best and most effective treatments can only be recommended by your doctor once a clear diagnosis is made which often requires undergoing a bone marrow procedure.
The Bone Marrow Biopsy Procedure
The patient is usually placed on the side or lies flat on the stomach to obtain the bone marrow specimens. An area above the buttocks near the pelvic bone is anesthetized with a local anesthetic. The solid bone marrow biopsy is recovered from this region using a bone marrow biopsy needle. The conventional biopsy needle which has been used for years is essentially a tube with a very sharp needle tip that cores a specimen into the needle as it is advanced into the bone marrow. Conventional needles do not have active capturing mechanisms and therefore must be manipulated once advanced into the patient to sever the specimen and help recover it. A smaller needle is used to aspirate the fluid bone marrow material into a syringe. Some physicians also use the biopsy needle to aspirate the fluid sample.
New Bone Marrow Biopsy Needles and Procedures
Recently, specimen capturing bone marrow biopsy needles have been introduced to minimize the pain resulting from manipulations of the bone marrow needle and to help your doctor ensure recovery of adequate specimens. The SNARECOIL TM bone marrow biopsy needle is a specimen capturing needle that incorporates a tiny internal snare mechanism that coils around the tip of the specimen after it has entered the needle and thereby captures it. This mechanism eliminates the need to significantly move the needle after it has been advanced into the bone marrow tissue to sever and recover the specimen. This advantage is relevant not only for the patient who may require a single bone marrow biopsy for diagnosis but especially for those patients with hematologic malignancies such as leukemias or lymphomas who may require multiple procedures to evaluate the efficacy of their treatments.
