PREM MAHENDRA

    Consultant Haematologist in Birmingham, UK
Consultant Haemato-Oncologist London

Procedures You May Undergo

Please select from the folowing:

- Bone Marrow Examination
- Lumbar Puncture
- Insertion of Hickman Line


Bone Marrow Examination (this include a procedures known as bone marrow aspirate and trephine biopsy)

Either test only takes a few minutes and you can have them done as an outpatient. The doctor takes the bone marrow sample from your hip bone.
The procedure is carried out with the patient lying on one side.

First you will have the area of skin cleaned. You will then have a local anaesthetic injection into the skin over the biopsy site - your hip bone - to numb it. When this has worked, the doctor puts the needle in through the skin, into the hip bone, and into the centre of the bone, where the marrow is. For a bone marrow aspiration, the needle is quite thin. For a bone marrow trephine, the needle is thicker. The needle is attached to a syringe.

If you are having a marrow aspiration, the doctor then sucks a cubic millilitre of bone marrow cells into the needle. You may feel a pulling sensation when the doctor starts drawing the bone marrow cells out. Some people have a sudden, sharp pain. If you are having a trephine biopsy as well, the doctor will take this needle out and put the second one in. Some times if the needle has touched a nerve you may feel a pain shooting down the leg on the side the marrow was taken.

If you are having a trephine, the doctor will turn the needle back and forth while pushing it further into the marrow. The aim is to get a 1 or 2 centimetre core of marrow out in one piece. Once it is in far enough, the doctor will draw out the needle, containing its core of marrow. The needle going into the hip bone will be painful, but it doesn't last for too long.

Some people prefer to have some type of sedative before the test so that they are a bit drowsy. Sedation of some sort is certainly a good idea for children. If you have a sedative, you will need to stay at the hospital until it has worn off. And you will need someone with you so that you don't have to go home on your own.

After the test, your hip may ache for a couple of days. You may need some mild painkillers to take home or your doctor may suggest you take some paracetamol. We also suggest that you lie on your back for at least 15 minutes after the marrow has been taken and that you leave the dressing on for at least 24 hours.

The results
The bone marrow may be sent for the following tests:

 
  1. Morphology
  2. Histology
  3. Immunophenotyping
  4. Cytogenetics

The first 3 results will generally be back in 7-10days. Cytogenetic results can take 2-4 weeks to come back.


Lumbar puncture

A lumbar puncture (also known as a spinal tap) is a procedure used to take a sample of cerebrospinal fluid (CSF) from the spinal canal so that it can be tested. Cerebrospinal fluid (CSF) is the fluid that surrounds your brain and spinal cord. It helps to support and protect the brain and spinal cord from trauma.

The CSF is tested because it is in close contact with the brain. Analysing it helps doctors find out how the brain may be affected by conditions such as acute lymphoblastic leukaemia or non-Hodgkins lymphoma.

The spinal canal is the passageway through the back bones (vertebrae) which contains the spinal cord.

A hollow needle is inserted into the lower part of the spinal canal to draw out the CSF. Usually only a few millilitres are taken. The procedure is carried out under a local anaesthetic

The procedure is very safe and takes place routinely without complications.

A lumbar puncture is carried out to determine if leukaemia or lymphoma has infiltrated the spinal fluid or brain.

A lumbar puncture can also be used to give chemotherapy drugs. This is mainly for patients with acute lymphoblastic leukaemia and some patients with non Hodgkins lymphoma.


Insertion of Hickman Line

A Hickman line is a soft plastic tube that is tunnelled beneath the skin and placed a large vein. The catheter can be used to take blood samples and give fluids, chemotherapy and blood products. The benefits of having a Hickman line are that it will save you from having repeated needle pricks during treatment. You will usually have a double lumen catheter; each lumen has a clamp in place which will be used when the line is not in use. The line is inserted in our x-ray department under a local anaesthetic. You will have 2 cuts made, one in your chest and the other in your neck or near your collar bone.

The line will need to be flushed weekly. Only patient requiring more intensive chemotherapy (usually acute leukaemia or more aggressive types of lymphoma) and those needing a stem cell transplant will have a Hickman line inserted.

NHS Patients

Centre for Clinical Haematology
Main Drive
Queen Elizabeth Hospital
Edgbaston
Birmingham B15 2TH

Secretary:
Angel Woodcock
Tel: 0(44) 121 627 2467
Fax: 0(44) 121 371 4397
Email Click Here

Private Patients

Priory Hospital
Priory Road Edgbaston Birmingham B5 7UG or Queen Elizabeth Hospital

Secretary:
Sheena Collins
Tel: 0(44) 121 446 1760
Tel: 0(44) 121 697 2443
Fax: 0(44) 121 446 1764
Email Click Here

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