Protocols for children with leukemia require bone marrow aspirations, a process by which bone marrow is sucked out with a needle. The purpose of the first, or diagnostic, bone marrow aspiration is to see what percentage of the cells in the marrow are abnormal blasts. Then these cells are analyzed microscopically to determine which type of leukemia is present. The next bone marrow aspiration occurs on day seven or fourteen of treatment. At this time, it is important to determine how many blasts are still present. This information helps the oncologists decide how intensive treatment should be. For instance, if the marrow is still crowded with blasts, the child might be described as a "slow responder," who would require a more intensive course of treatment.
Since the doctors knew that my daughter had leukemia from the blood work, they did her first bone marrow while she was under anesthesia to implant her Port-a-cath. This was a blessing as her marrow was packed tight with blasts.
Most centers require additional bone marrow aspirations at the end of each phase of treatment and at the end of maintenance (or postremission treatment, if your child does not require the maintenance phase).
To obtain a sample of the bone marrow, doctors usually use the iliac crest of the hip (the top of the hip bone in back or front). This bone is right under the skin and contains a large amount of marrow.
The child is placed face down on a table, sometimes on a pillow to elevate the hip. The doctor will feel the site, then wipe it several times with an antiseptic to eliminate any germs. Sterile paper may be placed around the site, and the doctor will wear sterile gloves. Then an anesthetic (usually xylocaine) may be injected into the skin and a small area of bone. This causes a burning and stinging sensation that passes quickly. The physician usually rubs the area to allow the drug to fully anesthetize the area. The physician then pushes a hollow needle (with a plug inside) through the skin into the bone, withdraws the plug, and attaches a syringe. The liquid marrow is then aspirated (sucked out) through the syringe. After a sample is obtained, the needle is removed and a bandage is put on.
If the child or teen is not sedated, removing the marrow can be very painful. Here are some descriptions from children and adult survivors who have experienced it:
It was the worst thing of all. It felt really, really bad.
It hurts a lot. It feels like they are pulling something out and then it aches. You know, it hurts so much that now they put the kids to sleep. Boy, am I glad about that.
It feels like they are trying to suck thick Jell-O from inside the bone. Brief but incredible pain.
I would become very anxious when they were cleaning my skin and laying the towels down. Putting the needle in was a sharp, pressure kind of pain. Drawing the marrow feels tingly, like they hit a nerve. I always asked a nurse to hold my legs because I felt like my legs were going to jump up off the table.
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