bone marrow biopsy

[Chirley]

Hi, I was wondering if anyone else has had trouble having a bone marrow biospy. I have had 4 BMBs but the doctors have never been able to get a trephine. Every doctor has told me that my bone is very hard and that they have had a lot of trouble just getting the aspiration. I was sedated for 3 of the BMBs but I had no sedation or pain meds for 1 of them (anterior iliac crest) and the needle kept slipping off the bone and stabbing me in the abdomen. I was watching the faces of the medical students, some of them turned a little pale. I read somewhere that the trephine is the most important diagnostic part of the BMB. I had a bone mineral density test too. This showed my bone had above average density. Anyone else had this? I would be interested to find out about other peoples experiences with BMBs and their results. Thanks Chirley

[Birgitta-A]

Hi Chirley,
Too bad that it is so difficult to get a relevant test of your bone marrow. It is unbelievable that the last doctor stabbed you in the abdomen!

I have had tree BMP with local anesthesia. My bone is very hard too and I have been glad that the doctors have been strong young men that have been able to get a biopsy every time. It doesn´t hurt at all since I have fibrosis and it is impossible to get an aspiration from my bone marrow (it is the aspiration that hurts). My bone marrow had not changed between dx May 2006 and September 2007.

I think it is common with high bone density when you have MDS.
Kind regards
Birgitta
68 yo, MDS interm-1 dx May 2006, transfusion dependent, Desferal 4 days/month, Neupogen 2 injections/week, Prednisolone 2.5 mg/day

[Chirley]

Hello, You were lucky that you had young fit doctors. For the first 2 biopsies I had a middle aged woman, the 3rd BMB was done by an elderly man who told me that I was very lucky he was doing it because he was very good. He was the doctor who kept slipping off the bone. THE 4th BMB was done by a young fit male doctor but he told me afterwards that it hurt his hand and he still couldn't get a trephine. I was frightened the first time I had a BMB but with the sedation it was painless. When I had the 3rd BMB the doctor said that he didn't think sedation was necessary, I was a bit nervous. It turned out that the BMB wasn't as painful as I thought it would be. In fact, it was interesting to watch. It is 30 degrees here and there is a storm coming so I had better move my cockatiel under cover. Bye Chirley

[Tom M]

Hi Chirley - I, too, have very dense bone. I have always had local anesthetic and great difficulty in penetrating my bone. The last bmb, I went to the hospital for a cat scan of my hip for the thinnest area of bone. The doctor marked the location and was able to insert the needle without much difficulty. This is the only way to go, for me anyway. It was so much more comfortable than having him pressing and pressing, slipping off of the bone, and even breaking the needle on one attempt to push through my dense bone. As they say, try it, you'll like it. I hope this helps.

[Chirley]

Thanks for that Tom, I'll keep the Cat scan idea in mind if I need any more bmbs. I have told my doctor that I don't want any more investigations (including bmbs) unless my blood tests suddenly change and get a lot worse. I'm happy just to keep having the blood transfusions, they aren't that much of an inconvenience compared to some of the other things that have been mentioned. It's interesting to hear that other people have hard or dense bone. I wonder if it's a coincidence or whether it's a sign of bone marrow problems? Any one else have this problem? Chirley

[Birgitta-A]

Hi Chirley,
If you look at PubMed you will find that hard bone (osteosclerosis) can be found in patients with myelofibrosis (fibrosis in the bone marrow) of different types for example Primary Myelofibrosis (my dx June 2006-September 2007), CLL etcetera. I don´t think anyone knows exactly why we have osteosclerosis.
Kind regards
Birgitta

[HarleyRider1176]

Hi,

I turned 62 in January, had my yearly physical, the primary physician said I had problems with low Red Blood count, ran another test and referred me to a blood doctor. I had no idea what Hematologists do, I thought I was getting a B-12 shot.

The Hematologist said my red blood was 4.44 low MCV high at 105.4, my MCH high at 34.9, RDW High at 15.2 and PLT low at 125. He said he thought it might be MDS, to wait 2 months and if my counts don't change he will begin aggressive treatment starting with a bone marrow biopsy.

I'm still thinking I needed a B-12 shot. My only symptons was feeling tired and lathargic but felt it was part of being 62. My head, like everyone who is told they have MDS is "spinning"

[Marlene]

Did either of your doctors do blood tests to check your B12, B6, folate, iron, copper and zinc levels?

If so, do you know the specific results? You want to see the actual lab report. A low normal B12 would, IMO, would be suspect.

You can supplement B12 orally just as effectively as with a shot.

I find it a bit troubling that your hematologist would kind of diagnose you without having the labs to back up a diagnosis.

[cathybee1]

Seconding Marlene here, our experience has been that not all hematologists are equally knowledgable.

Deficiencies in the vitamins and minerals she listed can mimic bone marrow disease, so it's important to rule those out first. Your regular family doctor could order those tests.

A bone marrow biopsy, by the way, is a diagnostic tool, it is not treatment. It is actually one of the ways MDS is ruled in or out.

[tytd]

Hello HarleyRider,
I agree with Marlene and Cathybee1 but would be very surprised if your primary care doctor or hematologist has not already checked a B12 level and MMA. Most doctors would check a B12 and folate level when the MCV is high and they have not made a diagnosis yet. I suggest that you ask for copies of all your blood work that has been done recently and ask them if you've had these tests. You may well have MDS but at least the more easily treatable things need to be ruled out which I assume has been done, but you never know until you check it out. Good Luck! tytd

[oasiswoman]

In 1991 at The University of Minnesota, I was seeking a second opinion for an Aplastic Anemia diagnosis. The DR. there had to perform 7 bone marrow aspirations...actually as I recall,(was somewhat groggy) it was 4 by the Dr. and 3 by the big huge lab tech. because he was the only one who had a prayer of getting through. I was then questioned for some time as to my diet...etc. I don't recall any remarkable answers to their questions. Anyone else had this type of experience?