Have you been asked to have a bone marrow biopsy? Don't worry, let's find out exactly what it is!

Perhaps your doctor has noticed something unusual in your blood test results and has told you to have a bone marrow biopsy. It's normal to feel a little scared and nervous when you hear this name. "Who wouldn't be scared when they say they're taking a piece of bone?" you might be thinking. But once you know exactly what this is, why it's done, and how it's done, you'll feel a lot of relief. Let's talk about this simply and in a way that you can understand.

First, let's see, what is bone marrow?

When we say "bone marrow," some people think of something in the brain. But that's not the case. Simply put, bone marrow is the soft, spongy tissue inside the large bones in our body, like the hip bone for example. Like the sap inside a tree trunk, the marrow inside our bones is called bone marrow.

This part of the bone marrow is the main blood-producing factory in our body . All three types of blood cells that are essential for our body are produced here.

• Red blood cells: These are the cells that carry oxygen from the lungs to the rest of the body when we breathe. These cells are essential for us to stay energized and perform tasks effectively.
• White blood cells: Like the army in our country, these cells protect us from diseases by fighting germs and disease-causing organisms that enter the body.
• Platelets: When you have a small cut and start bleeding, these platelets stop the bleeding after a while. They clump together to form a blood clot and seal the wound.

So, there is another part of the bone marrow, which is the liquid part. This liquid part contains the stem cells, that is, the newly formed blood cells. In a Bone Marrow Biopsy, the main part of the tissue is taken, which is like a sponge. The test used to take that liquid part is called a Bone Marrow Aspiration . Usually, your doctor will do both of these tests at the same time.

Why would a doctor recommend this test?

Imagine, if you suspect that there is something wrong with the engine of a vehicle, what a mechanic does is open the bonnet and check the engine thoroughly. In the same way, if a blood report shows that there is something wrong with our blood, the doctor needs to go deep into the blood factory, that is, the bone marrow, to see what the real problem is.

This test is mainly done for three reasons:

• Diagnose or confirm a disease: If your blood test shows an abnormally low or high number of red blood cells, white blood cells, or platelets, this test can help determine the cause. This is essential for diagnosing certain blood-related diseases, cancers, and unexplained fevers.
• Determine the stage of cancer: Once a person is diagnosed with cancer, the stage of the cancer is determined to determine how far it has spread in the body. This test is used to determine exactly whether the cancer has spread to the bone marrow.
• To see how the body is responding to treatment: Doctors also use this test to see if the treatment is successful and if the bone marrow is starting to produce healthy blood cells again, especially in someone undergoing treatment for diseases like cancer.

What diseases can be detected with this test?

A bone marrow test can detect many conditions in which the number of blood cells is abnormally low or high. It is also important for diagnosing cancers that affect the blood or bone marrow.

How should you prepare before the test?

This is not a major surgery, so there is no need to prepare too much. However, it is important to follow your doctor's instructions exactly.

• If you are given a sedative to help you relax during the test, you may be asked to fast (not eat or drink) for a few hours before the test.
• If you are given such a medication, you will not be able to drive after the test, so arrange for someone to take you home in advance .
• The most important thing is to tell your doctor everything about yourself.

What happens during the test?

This test can be done in a hospital or clinic. The entire procedure takes about 30 minutes . You are conscious, but the area being tested is numbed (local anesthesia), so you won't feel much pain.

Here are the steps that usually take place:

1. First, you will be put on a hospital gown. Then, you will be made to lie down on a bed. Usually, this test is done on the back of the hip bone (`posterior iliac crest`), so you will be turned onto your stomach or side and made to lie down.

2. Next, the doctor or a trained nurse will thoroughly clean the area to be examined with an antiseptic solution. Then , a very fine needle will be used to inject a numbing agent under the skin until it reaches the surface of the bone.

3. After you are numb, the doctor will make a small incision in your skin and insert a special needle into the bone. First, a syringe is attached and a small amount of the fluid is removed. This is called a bone marrow aspiration .

4. Then, another needle with a hollow inside is inserted and a small, cylindrical piece of the spongy tissue is taken. This is called a core biopsy .

5. After taking the sample, the needle is removed, pressure is applied for a while to stop the bleeding, and a plaster or bandage is applied.

The sample taken is sent to the lab for testing.

Does this really hurt that much?

This is the biggest question on everyone's mind. Let's be honest. Because of the numbness, you don't feel the skin being cut or the needle being inserted into the skin.

However, when the liquid part (aspiration) is drawn with the syringe, you may feel a sharp pain for a few seconds . Also, when the solid tissue part (biopsy) is taken, you may feel a tightening or pulling discomfort because the bone cannot be numbed. This is not unbearable pain, but there is discomfort.

What do you do after the test?

You can go home the same day. If you were given medication to calm you down, someone should drive you home. Follow these steps after you go home.

• There may be some pain for a day or two where the test was performed. Take a painkiller as prescribed by the doctor.
• Avoid strenuous activities such as exercise and lifting weights for at least 24 hours .
• Keep the wound area watertight for 24 hours . This means covering the area when bathing.

Side effects (risks) and when to talk to your doctor

Serious complications after this test are very rare . Sometimes there may be excessive bleeding or infection, but these are usually manageable.

However, if you experience any of the following symptoms, call your doctor immediately .

What happens after the report?

A pathologist , a doctor who specializes in tissue testing, examines your bone marrow sample under a microscope and prepares a report.

Your doctor will then review the report and explain it to you in simple terms. The results will determine what to do next. They may confirm a diagnosis, order more tests, or start treatment or change the treatment you are currently taking.

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