1

Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY

The Effectiveness of Bone Marrow Biopsy

Christopher Walker

Harrison High School

 2
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY

Abstract

In this year’s science fair, I plan to analysis and review the Effectiveness of Bone

Marrow Biopsy (BMB). This will be a two-year process. In the first year I will review the

current procedures used to perform BMB and research how they could be made better and less

painful for patients. In year two, I will create a model that demonstrates the new procedure that I

propose will make BMB’s better for patients which maintains its effectiveness for diagnosis of

disease. Scientist who have studied this problem or tried to solve it didn’t have enough

information to complete their study or they were unsuccessful in the process. My idea is to first

learn more about biopsies myself and use my mother as a research subject to see how the

procedure is done because she must get a bone marrow biopsy every year. Then I discuss how I

will make and construct the product. People who’d benefit from this project would be patients

who must receive a BMB on a regular basis and/or older patients who may not handle the current

procedure used due to several factors. It would benefit them because they won’t be as nervous

having to receive a bone marrow biopsy because it’ll be a less painful experience and it will

provide them with better results.

 3
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY
The Effectiveness of Bone Marrow Biopsy Introduction

Bone marrow biopsies are procedures that are used to collect and examine bone marrow.

Bone marrow biopsies show whether a person’s bone is healthy and making normal amounts of

blood cells. Doctors use these procedures to diagnose and monitor blood and marrow diseases,

including some cancers, as well as fevers of unknown origin. Bone marrow has a fluid portion

and a more solid portion. In bone marrow biopsy, a doctor uses a needle to withdraw a sample of

the solid portion. Bone marrow exams are often performed on an outpatient basis with

anesthetics. In some cases, a sedative medication is part of the procedure.

A doctor may order a bone marrow biopsy if a patient's blood tests show elevated or

reduced level of platelets/white and red blood cells. When this occurs, a BMB may help

determine what’s causing the abnormalities which include cancers of the bone marrow or blood,

such as leukemia or lymphomas. Since my mother must have a bone marrow biopsy every year,

I’ve been asking her questions about the procedure and collecting research from her experience

with the procedure.

Bone marrow biopsies are not known for high risks or side effects, but if some occur the

patient will have excessive bleeding, allergic reaction to anesthesia, or infection. Some other

disadvantages include: expensive for the procedure; difficulty in extracting the samples from

obese patients as their skin is thicker, making it difficult to find the bony area; and use of various

will pain killers that may have side effects. Bone marrow biopsy is known to be a very painful

procedure. Scientists and researchers have tried to reduce pain or improve the BMB procedure.

However, only a handful have found some possible ways in order to make this happen. These

ways include methods to both improve bone marrow biopsies by reduction of a patient’s pain

and new devices or techniques that could eventually replace bone marrow biopsies altogether.
 4
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY

Literature Review

Studies show ways to reduce or improve the pain in a bone marrow biopsy. The group of

hematology experts at the American Society of Hematology (ASH) wanted to figure out a way to

improve the quality and length of bone marrow biopsies (BMB) for better diagnostic accuracy

(Nazeef 2015). They observed and collected data on 212 consecutive BMBs performed on adults

for evaluation. Those were compared to 104 historical marrows. From their findings, they

concluded that there was no difference in biopsy lengths before or after initiation of study.

However, the Department of Hematology at the medical field of University of Warsaw were

more focused on how to reduce pain in the procedure rather than improving the quality of BMB

(Hematol 2013). From their research, they found some ways in which the pain would be reduced

but not in a way where the patient has no effect or pain at all. One of the ways they thought the

pain can be reduced was through pharmacological procedures. They wanted to mix

pharmacological substances with intravenous sedation (IVS) to reduce the pain during a BMB.

This idea of pain reduction failed because patients who receive IVS are prone to have to undergo

a future BMBA. Furthermore, IVS administration has serious setbacks such as prolongation of

the hospital stay, requirement of additional staff and equipment, and it contributes to an increase

in incidence of adverse effects. As a result, researchers concluded that premedication with a left

atrium (LA) alone or in combination with IVS did reduce pain but didn’t prevent unbearable

pain. Another way they wanted to reduce the pain was through nonpharmacologic procedures.

This strategy involves a person’s anxiety before a BMB. Establishing trust by honest accurate

information in terms that the patient can understand and ensuring comfort and privacy can lower

the patents’ anxiety. A survey of data clearly indicates the influence of information provided by
 5
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY
the physician on pain during a procedure (Hematol 2013). Patients who reported to have received

information about the procedure could enable a mental strategy and experience unbearable pain

less often. From this, the researchers concluded that this strategy was effective, but patients still

felt pain doing the procedure. The last way they thought that could reduce pain was hypnosis.

Worldwide, hypnosis has been used as an adjunct to local anesthetics and showed to be

beneficial. In one study, hypnosis has been used to lower the anxiety doing a BMB procedure but

didn’t show any significant decrease in pain (Hematol 2013). The researchers were able to

conclude that so far, there is no formal recommendation on how to reduce pain during the bone

marrow biopsy.

Aside from pain management or reduction, researchers have also focused on new devices

or techniques to replace bone marrow biopsies. The development of new equipment such as

biopsy needles with internal snares that capture bone marrow shortens the discomfort experience

by the patients. It also allows easier biopsy for the physician when used correctly (Figueiredo

2018). In addition, a new device called the OnControl Bone Marrow Biopsy System was

introduced recently (Figueiredo 2018). This device was tested in a small trial. The researchers

were able to conclude that the device showed similar pain compared to the conventional biopsy

needles. In two other research studies, their goal was to try and find and create a new way of

taking a bone marrow biopsy. One team of researchers at the University of Kansas developed an

experimental reliable blood test called the chip-based blood test (Figuiredo 2018). This test is

designed to deliver the same diagnostic information as a bone marrow biopsy. The test uses a

device that exists on a plastic chip with specific antibodies attached to the surface of sinusoidal-

shaped micro channels. These allows for an efficient capture of rare and specific cells. To

capture circulating plasma cells, researchers used antibodies against CD138; which is a protein
 6
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY
known to produce in both normal and infectious plasma cells. Blood samples from different

patients were diagnosed with different plasma cell disorders and healthy people were analyzed

for the presence of CPCs. The device detected CPCs in 78% of patients with MGUS and none in

healthy individuals. The results suggest that the new chip can improve diagnostic testing

performance and accuracy compared to previous chips for multiple myeloma. The researchers

concluded that the chip is a success but will still need to undergo testing by BioFluidica. The last

research study developed and tested a less invasive diagnostic and monitoring tool for multiple

myeloma (Brueggeman 2018). During the study, a plastic chip-based technology was used with

whole blood to detect MM cells or circulating plasma cells. From this, researchers found that

78% of patients with MGUS were correctly identified and 100% of all MM/SMM patients were

identified. The researcher concluded that they found all the research they needed and will

continue to work with the technology.

BMB’s are a useful and necessary medical procedure for the diagnosis of blood

disorders. They have been proven to be highly efficient and accurate for their intended purpose.

However, the procedure is less than ideal from the patient’s perspective. Therefore, further

research into possible improvements and potential replacements is desired. From all the

information that I have gathered, I have concluded that there are ways that can be further

expanded and perfected to reduce, improve or eliminate pain in bone marrow biopsies while

maintaining the diagnostic capabilities and accuracy seen in today’s standard BMB procedures.
 7
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY
Method

Research Question(s): Can the pain during a bone marrow biopsy be eliminated or improved?

Hypothesis: Bone marrow biopsies are effective, but they should be improved or replaced for

the betterment of the patients.

Engineering Goal(s): I would like to find and create a way to reduce patient’s pain during bone

marrow biopsy procedures by improving current techniques and/or replacing the current

technology all together.

Expected Outcomes: I expect to develop new techniques that can be implemented into current

bone marrow biopsy procedures and seek to study immerging technologies that can be improved

upon to enhance or replace current procedures for the betterment of patients.

Procedure:

 Research current methods, procedures, and techniques to better understand the current

process and implementation of bone marrow biopsies.

 Research current efforts to improve bone marrow biopsy procedures.

 Visit facilities, hospitals, and pharmacies to learn more about how biopsies are performed

and gather opinions of technicians and providers regarding possible improvements.

 Review videos and biographies of current procedures to better understand current

methods in action.

 Examine current tools used in bone marrow biopsy procedures.

 Research emerging technology and efforts to replace current techniques.

Risk and Safety:

 8
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY
 Obtain clearance and approval to shadow a nurse/doctors and other providers.

 Use proper safety equipment when visiting health facilities and observing procedures.

Data Analysis

In a bone marrow aspiration and biopsy, a doctor or nurse uses a thin needle to remove a small

amount of liquid bone marrow, usually from a spot in the back of your hipbone (pelvis). The

second part of the procedure removes a small piece of bone tissue and the enclosed marrow.

Current Bone Marrow Biopsy procedure:

Pros:
 Diagnose a disease or condition involving the bone marrow or blood cells
 Determine the stage or progression of a disease
 Check iron levels and metabolism
 Monitor treatment of a disease
 Investigate a fever or unknown origin
Cons:
 9
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY
 Excessive bleeding
 Infection
 Long-lasting discomfort at the biopsy site of placement
 Very painful
 Penetration of the breastbone(sternum) during sternal aspirations can cause heart or lung
problems

Pain levels Chart of Different bone marrow procedures

Research attempts at New Procedures:

The Microfluidic Device: Future Replacement for Bone Marrow Biopsy in Multiple Myeloma

Pros:
 Diagnostic and monitoring tool for multiple myeloma.
 A plastic chip-based technology is used with whole blood to detect MM cells or
circulating plasma cells.
 The microfluidic device captures the CPCs and they can be washed off the device and
utilized in advanced molecular and cytogenetic techniques for further genetic profiling.
 10
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY
Cons:
 Prior chip iterations have had significant cost, rendering this method of analysis as too
much of a financial burden to healthcare and patients to be implemented broadly.

Chip-based Blood Test Might Replace Bone Marrow Biopsies for Myeloma, Scientists Say

Pros:
 Introduced a new way for taking a Bone marrow biopsy without a drill.
 A plastic chip with specific antibodies attached to the surface of sinusoidal-shaped micro
channels, which allows for the efficient capture of rare and specific cells.
 It costs relatively little to produce because it’s made of plastic.
 It can process a blood sample directly without pre-processing.
Cons:
 Additional studies are needed to examine the prognostic value of CPC detection in
plasma cell disorders using the new device.

New Strategies of pain reduction during the Bone Marrow Biopsy

Pros:
 Introduced some pain reduction procedure.
 Pharmacologic, IVS, Nonpharmacological, Different types of biopsy devices, Hypnosis:
all different strategies to try to alleviate pain during BMB.
 Their observations suggest that they can be easily adopted into clinical practice and could
be great to help patients.
Cons:
 There was no formal recommendation on how to effectively reduce pain during the bone
marrow biopsy: this means they were unsuccessful in their research.
 Introduced some pain reduction but not in away where the patient has no effect or pain at
all through the biopsy.
 Get test subjects to help get data to test.
 11
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY

Discussion
BMB’s are a very important take in the fight against blood disorders, cancers and other illnesses.
Although they have been proven to be reliable in the diagnosis of illness, they are not the most
patient friendly procedures. However, this does not have to be the case as we move forward in
the future. It is possible to maintain the reliability of BMB while at the same time improving the
effect and experience on the patient. It is my intension to help research and assist in the
development of improvements to BMB and eventually replace the current techniques with new
and improved technologies that are just as reliable but less detrimental to the patient.
 12
Running Head THE EFFECTIVENESS OF BONE MARROW BIOPSY

Reference Page

Bone Marrow Biopsy Quality: A Quality Improvement Project to Identify Factors Affecting
Bone Marrow Biopsy Length and Find Strategies to Improve Overall Biopsy Quality. (2015,
December 3). Retrieved from http://www.bloodjournal.org/content/126/23/3323?sso-
checked=true
Strategies of pain reduction during the bone marrow biopsy. (n.d). Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3542425/
Bone marrow aspiration in north Sudan: the procedure, indications and the diagnostic value. (n.d.). Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682598/
Chip-based Blood Test for Myeloma Might Replace Bone Marrow Biopsy. (2018, May 2). Retrieved from
https://myelomaresearchnews.com/2018/05/02/chip-based-blood-test-myeloma-might-replace-bone-marrow-
biopsy/
The Microfluidic Device: Future Replacement for Bone Marrow Biopsy in Multiple Myeloma. (0500,
January). Retrieved from https://www.labroots.com/trending/cancer/8677/microfluidic-device-future-
replacement-bone-marrow-biopsy-multiple-myeloma

Study Says Biopsies Are Safe. (2015, January 9). Retrieved from
https://www.webmd.com/cancer/news/20150109/study-says-biopsies-are-safe
Biopsy. (2018, March 5). Retrieved from https://www.cancer.net/navigating-cancer-
care/diagnosing-cancer/tests-and-procedures/biopsy
Bone marrow biopsy and aspiration - Mayo Clinic. (2018, November 28). Retrieved from
https://www.mayoclinic.org/tests-procedures/bone-marrow-biopsy/about/pac-20393117