Is A Repeat Bone Marrow Biopsy Called for

@richardab. Depending on the patient’s medical needs, bone marrow biopsies (bmb) are ordered to check progression of blood diseases. The bone marrow is the blood manufacturing site for all the blood products in the body. A biopsy and examination of the marrow and the peripheral blood in the marrow helps give your oncologist a clear picture of the health of your marrow and blood.

Your bmb of several years ago gave a baseline for what your bone marrow capabilities were at the time. If blood numbers are changing, your doctor may place orders to have that repeated to see if anything of significance has changed. Keep me posted, ok?

Lori, thank you for taking the time to respond. I'll let you know what the oncologist says in a few weeks. Much appreciated.

Richard

Hi Lori, well, a new heme/onc did order a BMB to recheck numbers. Unfortunately, the lab reported that all collected samples were not sufficient for them to analyze. Not making me real happy.

Hi Richard. Oh bummer, I know this is frustrating and disappointing for you to have a ‘failed’ bone marrow biopsy. No one looks forward to having a repeat.

It sounds like you maybe had a dry tap where there just isn’t enough of the liquid portion of your bone marrow to aspirate. There are two portions to a bmbx. (Bone marrow biopsy and exam) The core sample of the marrow itself and the aspirate, which takes the liquid portion to analyze. The liquid portion of the biopsy provides material for flow and molecular studies. If there isn’t enough of this ‘liquid’ portion, from my understanding, it can be difficult to get a broad perspective of the types of cells and to give a definitive diagnosis.
Most often when a dry tap occurs it’s not through the fault of the technician but that there may be an underlying issue with the marrow itself. Were the core marrow sample results inconclusive too?
Have you spoken to your doctor yet or did this information just pop up in your portal?

Hi Lori, I was told by another oncologist that up to 5% of these procedures fail. I understand that although I'm unsure how the surgeon wasn't aware while obtaining the samples. Had a very brief cursory talk with the heme/onc's nurse on holding off on another biopsy for now as he's not convinced of the need. He's a replacement for the oncologist who ordered the test as that one disregarded a serious health concern of mine. I'm not too sure of this health network at this time. Thank you for your input and taking the time to answer.

Hi Richard. While there may be a procedure failure in some cases there is also evidence that dry tap can be related to a problem in the marrow that is disrupting the normal developing of blood products. I’ve had 13 biopsies done over the years and have learned a great deal about the procedures and the value of the results in what they can tell my doctor about my bone marrow/blood health.

From my understanding it isn’t always obvious if it was a dry tap at the time. In case of a dry tap, the marrow can be used to make a specimen plate if done quickly before the core sample is immersed in formalin for preserving. I don’t know if that was done in your case or not. I’m guessing not since it looks as though all samples were inadequate for testing. But does that mean the bmbx was improperly done or is there something interfering with normal marrow?

In any event your biopsy wasn’t usable but that doesn’t answer why your doctor ordered it in the first place.
What prompted your doctor to run another biopsy? Were you having changes in your blood numbers?

Hi Lori, I was starting with a new heme/onc, the previous one had left the practice. My numbers have declined a bit, the SPEP was pretty wonky. He ordered the BMB as the previous one was over 4 years old and he wanted to assess changes. He also ordered a Pet CT scan. The heme/onc who has taken over my care is going to hold off on another for now.

The PET scan will be helpful and I am wondering how you are feeling. Are you having increasing symptoms such as fatigue or do you have abnormalities in your blood test like high calcium or abnormal kidney function test. Bone pain fever night sweats are important to report to your doctor for ongoing monitoring . If you do have another bone marrow biopsy, I would highly suggest, you ask for it to be done under sedation. I have had two biopsies and would not consider doing one without conscious sedation. It’s very disappointing to go through a procedure like that without adequate results. Are you on any treatment and has treatment been considered since your plasma cell percentage four years ago was 40% I hope your new oncologist is a good one and works with you in a reasonable safe and compassionate way. We all deserve that.

Hi Lori, no treatments yet, doctors not convinced of the need yet as other analyses, while declining, haven't put me in the category of active Multiple Myeloma. Really bad Chronic Fatigue but the heme/onc I fired told me it wasn't being caused by cancer and he wasn't going to address it. He also blew off my reporting dimming eyesight with black spots and flashes of lights because "it wasn't caused by cancer". Needless to say, an opthamologist told me to come in immediately and found the central vein in my left eye is completely occluded so I'm geetting injections to hopefully reduce the swelling. Perhaps the sight will come back, maybe not. However, that doctor blowing off my concern violated his oath of office.

What does it mean if the collections weren’t sufficient.