Should I get a bone marrow biopsy?
February 3, 2012 3:32 PM   Subscribe

My platelet count is low, but not crazy-low, and has been for a couple of years. I just volunteered to get a bone marrow aspiration and biopsy. Am I insane?

Background: A couple of years ago, my doctor did a CBC and noticed a low platelet count (I think it was about 114.) He asked for some more blood tests, they came back okay, and I didn't worry about it anymore. This past spring, I went in for my first physical in approximately decades, and my doctor said I was fine, but he was worried that my platelet count was low. He referred me to a hematologist, who asked for blood tests every three months. The platelet count on those was consistently low; 114, 87, 97. But not super-low. And the rest of my bloodwork seems fine.

I'm not noticing any abnormal bruising; some bleeding from my gums when I floss, and occasional low-grade nosebleeds when the weather is really dry. Other than that, no symptoms at all.

When I talked to my doctor today, he mentioned a biopsy, but said he'd just as soon wait and see what happens with another blood test in three months, then another appointment in six. But if I was really worried about it, they could schedule a biopsy right away.

I have been worried that it might be serious, to be honest; I'm kind of phobic about cancer. A biopsy would pretty much eliminate the possibility that it's pre-leukemia, or a number of things. The thing is, all my other bloodwork is normal, so the chances of it being that is really low anyway.

The doctor said he was glad I'd decided to get the test, but he was really noncommittal throughout the appointment. It's really hard to tell if he's recommending the test, or not.

It's a painful test, from what I hear, and it may not be necessary. I'm having second thoughts about it already; I keep feeling like a total hypochondriac. After all, there's nothing really wrong with me. It's really tempting to call up and cancel.

And how bad is a bone marrow biopsy (in the hip), anyway?

Any advice, suggestions, or experiences with this or similar matters would be appreciated.
posted by MrVisible to Health & Fitness (12 answers total) 1 user marked this as a favorite
You are right that it is painful, uncomfortable and irritating.

You should do as you think best. But I'd wait for further blood tests. I have blood loss problems and get a transfusion every month. Because of my age and condition the doctor said they would not do anything, no matter the bone marrow biopsy results. But you may not be in that category. You do what you think best for yourself but I'd certainly take the recommendation of your doctor seriously.
posted by JayRwv at 3:54 PM on February 3, 2012

I've had a bone marrow aspiration to rule out leukemia. It was done during a hospital stay (for the disorder the doctors were trying to diagnose), so I don't have experience with it as an outpatient procedure.

I can't say I wasn't nervous about having an aspiration done. They gave me some intravenous morphine, which hit me like a ton of bricks. I flipped over on my stomach and bared the small of my back. I dimly felt a pressure, and then the doctor punctured the bony part of my iliac crest, and, I guess, took a small sample of the tissue inside. Then they put a bandage on the site. I was allowed to lie on my back immediately and could move around once the morphine wore off. I experienced no pain either during or after the procedure, although I did have a dull funny feeling in the small of my back for a day or two afterward.
posted by Nomyte at 4:04 PM on February 3, 2012

What is the reference range on your tests? It may depend on the lab. I have had low platelet count for 11 years so far (maybe longer, but I only have test data for 11 years), though probably slightly higher than yours usually around 119 - 127, with the reference range of 143-398. No leukemia that I know of. You can ask for more tests that can give you a bit more data. For example, in my latest test, they indicated that giant platelets were detected. That can give the doctor more info on what's behind the low count and whether it's something to be worried about. In the 11 years I've had these results, I've had 3 different PC physicians, and I discussed it with every one of them, but it was always me who brought it up. None of them seemed concerned. I would point out "bbbbut it's outside the range!", and they'd all say the same thing more or less, which is that unless the count is much lower, or you have other results that come out abnormal, or have some kind of symptoms such as excessive bleeding or bruising, it's nothing to be worried about. Nobody suggested a bone marrow biopsy. All the PCs were at a major medical center (UCLA). So one data point. Of course, your count is slightly lower than mine, so maybe that's more concerning, IANAD, but by the sound of it, the PC's seemed to think it had to be way lower than even yours to be concerned.
posted by VikingSword at 4:08 PM on February 3, 2012

Like VikingSword, I also had a similar number for my platelet count during a routine CBC (27 years old at the time). The doctor wasn't too worried but had me come back a couple months later to check again. Came back the same. He said, eh, not a big deal, some people have to fall outside of the 95% reference range. Four years later and I'm still alive.
posted by Durin's Bane at 4:15 PM on February 3, 2012

Doctors have gotten in the habit of offering treatment/tests even when they're reasonably sure nothing is going on as a CYA play.

Research shows that patients want a choice in their healthcare decisions - whether it does them any good in the long run or not is a different question.

It may be that he's just giving you a choice so you feel more control in your healthcare.

Or, if it's like where I work, it's part of a "patient centered care" policy.

What was your reaction when he suggested a biopsy might be in your future? Maybe that drove him to say you could have it now if you wanted, rather than later.

IANAD either, but it sounds like he thinks you'll do just fine with watchful waiting.
posted by Momorama at 5:06 PM on February 3, 2012

I had a bone marrow biopsy several years ago, but I think my platelets were in the 50s at the time (I have ITP, and bone marrow biopsies are used to rule out other conditions when diagnosing it).

My hematologist performed the procedure in his office with a nurse assisting and it hurt like hell. Like, whenever some medical professional since then has suggested that some procedure might "be a bit painful", I think, "It can't be as bad as a bone marrow biopsy."

BUT I drove myself to work afterward (ice pack in...hip, as it were) and I was barely sore after a couple of days.

All that said, if your platelets have been consistently low but not falling for a couple of years now, I'd stick with your doctor's original suggestion of waiting on the biopsy.
posted by camyram at 5:54 PM on February 3, 2012

Best answer: To me it depends on three things:

1. How phobic are you? And what kind of fear is it, really?
2. What are the odds you're going to be doing a biopsy in the near term (say, two years)?
3. If the results are bad, how will you change your behavior?

1 - If I were spending more than about an hour a week, or half an hour at a stretch more than four or five times a month, worrying about cancer and the platelet thing, and was reasonably confident that a negative result would be actively reassuring, I'd do the test ASAP. If this were a "when I talk myself into worrying and don't fight it off it really upsets me, but I go weeks and weeks without even thinking about it, and it's not like I'm making myself puke with worry on the worst of days" thing, I'd wait it out.

2 - If the odds are better than 20% for me, I'd do it now. I also tend to make things worse for myself (psychologically) by waiting, and so I choose to actively fight that when I can, and push the button early at times just to avoid that cycle of unproductive decision-making. Are you going to be in a position where every four or six months you have to decide if now you're going to get that test? That will get old, and I'd end up caving (or stop going to the doctors, which is a very bad idea) pretty quickly under those conditions.

3 - If this is mostly going to mean that you need to eat better, have frequent blood tests, and exercise more: do those things now. If this could be the difference between chemo and not, or something equally dramatic (and impossible to do without insurance approvals) then get the test now.

At the moment, you cannot legitimately say that there's "nothing really wrong with you." You can say that you don't know if there's something really wrong with you, and that you aren't manifesting any worrisome symptoms, but there's a thing in the back of your mind that could be, you know, the wind in the trees, or it could be the first sign of something really bad, and you need more data to know for sure.

I hate uncertainty, personally. And I'm a big, big fan of pre-procedure pain relief in all its many splendid varieties (and I'm not at all shy about asking for it, thank heavens.) It doesn't really bother me to be seen as a bit of a hypochondriac. And my doctors always get my white blood count, every time I get a blood draw for any reason, because of "low but not too too low and we don't see X Y and Z so we can't call it anything but still" reasons; if they said "do this other thing which hurts but will definitively say you don't have Thing or Other Thing, which are very bad and a reason we worry about you," I'd sign up. I did my sleep study this week more or less because they said it might be a good idea. And hey, looks like I have moderate sleep apnea without any snoring or other "we can totally tell you stopped breathing from across the room" kinds of signs. You never can tell, except for that whole definitive diagnostic testing thing.

(Also: I know way too many people who've been diagnosed with shocking, no-symptoms-until-disaster-struck diseases that it turns out might have been caught if they'd had unpleasant tests sooner. I suspect the universe is trying to tell me to keep getting checkups.)

posted by SMPA at 7:35 PM on February 3, 2012 [1 favorite]

I am totally not a medical expert but my husband has low platelet counts (Doctors weren't worried when it was above 50k but very concerned when he was facing surgery for something else with a count below 20k.) I think that if you have leukemia, then it would affect your white blood cells as well as your platelets. Certainly no one has suggested cancer in his case. The current best guess is that his spleen is culprit. So, as a total amateur, I would think that (a) your count isn't that low and (b) the rest of your blood work is normal. I would suggest calling the doctor and asking him if he would expect to be seeing other symptoms if it really were a leukemia. Lots of doctors seem to be perfectly happy to order tests when it makes a patient happiers with their care plus makes more money for the clinic.
posted by metahawk at 8:49 PM on February 3, 2012

How bad is it?

Well, in my experience, not bad at all.

I had no general anesthesia. The local anesthetic works fine. The feeling wasn't so much a sharp pain, more of a strong pressure. No one really feels their hip being pushed on or their marrow being taken out unless they have had a bone marrow biopsy. It's a very weird feeling, but not painful. There is some pain, but it's not like it lasts throughout the whole procedure, which itself is only around 10 minutes long anyway. Afterwards, I didn't have any pain or soreness worse than any other cut. If you're really curious, you can watch videos of other people having it done on YouTube. You won't find people screaming in agony.
posted by aloysius on the mixing boards at 10:28 PM on February 3, 2012

I had a bone marrow biopsy done a few years back and aloysius on the mixing boards describes my experience almost exactly. I felt kind of bruised for a few days and was told not to go swimming for 2 or 3 days (which I remember because it was summer and I went to a party at the lake the next day). So in terms of discomfort it is not something I would worry about.

As for medical indications, platelet counts can be somewhat unreliable, as platelets tend to stick together (that's what they are supposed to do) and get misinterpreted by automated cell counters. A good lab will confirm the platelet count manually, but that is time-consuming. Also, many people don't realize that "normal" lab values are usually determined by sampling a healthy population (which was what I was being when I got my bone marrow biopsied) and taking normal as the mean plus or minus two standard deviations. So by definition 5% of healthy people will have an abnormal value for a given lab value. So a single abnormal number in the absence of other findings is no big deal most of the time. On the other hand, you describe a consistent pattern of low platelets, which is worth looking into a little more. How much more is up to you and your physician. Since you are already seeing a hematologist, you might want to ask him what diagnoses he is considering that a bone marrow would help determine. Then, depending on the likelihood and seriousness of those diagnoses, you may have an easier time deciding how to proceed.
posted by TedW at 5:01 AM on February 4, 2012

Response by poster: I thank you all for your input; everyone had really helpful, well-reasoned arguments, which echoed the back-and-forth I was going through in my head effectively.

I was about to take the thread's apparent consensus, and just wait and see, but I spoke with my mother. She's in the process of helping my sister, who's uninsured, through a health crisis. My mom pointed out that yes, I have a good job and health insurance and plenty of sick time saved up, but if anything happens to that, dealing with this uninsured would suck.

She's absolutely right. I have a good stable job that I'm happy in, that I do really well in, my performance appraisals are excellent, and... I have no way to predict what will happen in the next year. Right now, I can eliminate the low-probability worst-case scenarios.

I'm sorry this turned into another AskMe where the questioner ignores the overwhelming advice of the very well-informed and helpful majority, but finding this out while I'm insured makes sense to me.

Another good argument against employer-dependent healthcare.

Thank you for your help on this. I really appreciate it.
posted by MrVisible at 8:21 AM on February 5, 2012

Response by poster: A quick update; had the procedure done yesterday, and maybe it's the Demerol talking, but it was nothing. Getting a filling done a couple of weeks ago was worse. It was quick, the staff were efficient and polite, and after a day of feeling a bit groggy, I'm doing fine.

I find out the results on Wednesday, but damn, am I glad I went ahead with this. It'll be good to know for sure.
posted by MrVisible at 5:02 PM on February 9, 2012

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