Blood Work and Bone Marrow Sampling

Complete Blood Profile   identifies counts of white cells, red cells, platelets, and other indicators of blood composition. These tests determine the quality of bone marrow, kidney function, and liver function.

Protein Electrophoresis measures the amount of M protein in serum and urine samples collected from the patient. An abnormal amount of M protein is an indicator of the extent of disease. However, it is important to remember that myeloma cells may produce less or even no M protein as the disease becomes more aggressive.Blood Sample

Bone Marrow Aspiration and Biopsy are used to estimate the number of myeloma cells, their activity in the bone marrow, and the degree of damage they have caused to normal bone marrow structure; the bone marrow sample will   also be used for cytogenetics testing.  The procedure is preferably done on the back of the hipbone, although it may be done on the front of the hipbone or on the breastbone. The procedure takes about 30 minutes and is normally performed with a local anesthetic to numb the area. Bone marrow aspiration is done to withdraw a small amount of marrow. A needle is inserted through the bone into the marrow cavity, and the technologist or physician then attaches a syringe to collect the marrow   material. The needle is removed, and the insertion site is bandaged. As the needle enters the bone marrow cavity, the patient may feel some pressure and discomfort. Bone marrow biopsy is done to remove a sample of solid tissue. A larger hollow needle is inserted through the bone into the marrow cavity. A small incision is made through the skin, and the needle is inserted through the incision into the bone marrow cavity. Because the needle is hollow, a small piece of bone is retained when the needle is removed. The site is covered with a sterile dressing for a couple of days. This procedure does not leave a permanent hole in the bone, as the cells immediately begin to fill in the area to create new bone.

It is important to remember that myeloma often is a focal disease, meaning that there can be areas in the bone with large numbers of myeloma cells and areas with small numbers of myeloma cells or none at all. The aspirate or biopsy may hit a pocket of myeloma cells and overestimate the overall amount of myeloma cells. It may also hit a spot with no myeloma cells, while there is still myeloma present in other areas of the bone marrow.

Computerized Tomography (CT)-Guided Needle Biopsy may be necessary when MRI indicates the presence of myeloma. A CT scan is performed to locate   the exact position for the biopsy, and the biopsy needle is inserted into the area of bone destruction seen on the CT scan. This is more precise than a regular biopsy because the radiologist can pinpoint the site within a millimeter.

During a CT-guided needle biopsy, the patient is asked to lie on the stomach or back. A local anesthetic is administered to numb the area, the patient is moved in and out of the CT scanner to find the exact location for placement of the biopsy needle, and the biopsy sample is then analyzed. A CT-guided needle biopsy takes about an hour to perform.

Cytogenetics Testing identifies chromosomal abnormalities in myeloma cells from a patient’s bone marrow sample obtained during aspiration and/or biopsy. The chromosomal abnormalities for myeloma are specific to the myeloma  cells and are not present in other body cells. These chromosomal abnormalities provide physicians with a great deal of information about the specific type of myeloma, which significantly guides treatment.