Question:Does anyone know of ways to lessen the pain of a bone marrow biopsy?
Answer:There are two different things:
-- A bone marrow ASPIRATION
used for marrow smears for cytology, for cytometry, for cytogenetics.
It's a fundamental step in leukemia, myelodisplastic syndromes and
pernicious anemia where histology is poor and cytolgy reigns.
The best place for this is the sternum at the level of the second
intercostal space.
I use a 18G spinal needle for this. Paramedics and dumb people use
much thicker needles with an arrest plate so that they can't go wrong
even with bad technique...
This is painless (with proper local anest.) till the moment of the
aspiration. The vacuum inside the bone hurts and nothing can be done
about it. If you aspirate slowly it doesn't hurt but you're only
catching blood filtered by the marrow and not real marrow.
-- An osteo-medular BIOPSY
when you want a 2cm long bone cilinder for histology.
It's essential for staging of lymphomas, and diagnosing marrow
invasion, aplasia or fibrosis.
The best place is the postero-superior iliac spine.
Here you use a much thicker needle and you have to twist and brake the
fragment so that it comes out inside the needle. This hurts a little,
like pulling out a tooth at the dentist.
Same way, inserting the needle is painless (with proper anest) and you
can remove it gently and painless also... but empty, leaving the bone
fragment in place...
Neither of these procedures justifies the risk of a general anesthesia
for light it may be.
