It is important to tell the doctor or nurse about any tablets or injections you are taking before you attend for your bone marrow test, as they may have to be stopped for a short while before having the test. This is especially important for medications that thin your blood, for example warfarin, apixaban, rivaroxaban, edoxaban, dabigatran or heparin/enoxaparin. We also need to know about any allergies you may have.

The procedure takes about 15-30 minutes, and you should feel well enough to go home after a short rest. 

You should allow around an hour for this appointment. There are no special preparations, but it is sensible to have something to eat and drink beforehand or you may feel light- headed during the procedure. We recommended you ask a family member or friend to come with you and take you home afterwards. We advise you don’t drive home if possible. 

You will be asked to sign a consent form and will have the opportunity to ask questions beforehand. The procedure is done under local anaesthetic by a doctor or clinical nurse specialist. In some cases, nitrous oxide (gas and air), an inhaled painkiller, can be used. It is safe and it wears off quickly. Please ask if you would like to have this. 

Please ask us if you would like more information about pain relief during the procedure. You can phone us on the number in the how to contact us box.

The bone marrow exists throughout the body, in the cavities of the bones. The most common place to take a bone marrow is at the back of the pelvis (if you place your hands on your hips, the thumbs will be over the place where the bone marrow is taken). Marrow can also be taken from the breast bone (sternum) but this is unusual.

You will be asked to lie on your side with your knees tucked up. The doctor/nurse will first examine you carefully to choose the most suitable site. Then the skin will be cleaned using an antiseptic fluid. Local anaesthetic will be used to numb the skin and the surface of the bone.

The needle is then pushed through the skin and the outer surface of the bone until it reaches the bone marrow. You may feel some pressure as the needle is pushed into the bone. A syringe is then attached to the needle and a small sample of bone marrow is sucked out into the syringe. This produces an uncomfortable sensation, which may shoot down your leg. This only lasts a few seconds. The needle is then withdrawn, and pressure applied to prevent bruising.

If you need to have a trephine sample as well as an aspirate this will be done under the same local anaesthetic. You will again feel pressure and pushing as a new needle is rotated into the bone. You may feel a dull ache as the core is removed. Again, this might travel down your leg.

Once the procedure is complete, pressure is applied to the area to stop any bleeding and a dressing is applied to the area.

You will be asked to lie down and rest for a short time after the procedure to make sure there is no excessive bleeding. 

You may have some discomfort and bruising over the test site for a few days which can be eased with paracetamol. The dressing should be left in place for at least 24 hours while a scab forms. You are advised to keep the site covered for a further 2 or 3 days.

As with all medical procedures, there is an extremely rare chance that a problem may occur. These can include:

• Bleeding: in a small number of cases there is some bleeding from the biopsy site. This usually stops by itself. Very rarely the bleeding is more severe and may require a blood transfusion. If you are taking blood thinners, please inform us before attending for your bone marrow.
• Infection: there is a very small risk that the small wound may become infected. Please contact us if you are concerned.
• Allergy: rarely you may have an allergic reaction to the anaesthetic, cleaning solution, or dressing.
• Damage to nearby structures: rarely the needle damages other nearby structures (for example nerves and muscles).
• Insufficient sample: occasionally, it may be necessary to repeat the procedure if the sample is not of suitable quality for testing in the laboratory.
• Pain: pain should be well controlled after the procedure with simple paracetamol. Please refer to the Post Bone Marrow information if this is not the case.

It would be difficult for your doctor to make the right diagnosis and decide on the correct treatment for your problem.

The laboratory tests can take two to three weeks to complete, depending on the information required. Your doctor will discuss with you when and how you will receive your results.

You will be asked to attend the Medical Day Care Unit at Gate 5b (Room 28) Southmead Hospital for your test.

Medical day care schedulers

0117 414 3206 
0117 414 3205
09:00 - 16:00

Clinical Nurse Specialist 

07545 421 893 
This number has an out of hours answer machine. We will get back to you within one working day.

You can be referred at any stage of your baby’s admission to NICU.

If you would like to be referred, please ask any member of your hospital care team such as your baby’s nurse.

• You will be contacted to arrange a time to meet, either in hospital or via phone/video call if you prefer.
• The psychologist can see you on your own or with your partner or other family members. It is your choice.
• If you require an interpreter, please let us know.
• The first meeting is an opportunity to talk about what is most challenging for you. We can think together about what might support you while your baby is in NICU.
• There may be a small wait for appointments.
• Sometimes we have trainees working in the team, all of whom are supervised. We will check first to see if you are comfortable meeting with a trainee.
• Sometimes, it may be enough to meet with a psychologist once or twice, other times you may wish to meet more regularly.

Any information you share with the psychologist is confidential. This means it will not be shared without your permission unless there is concern about risk of harm to you, your child, or others.

Parents sometimes find it useful to share information with the clinical team to help them understand the best way to communicate with you, and care for your baby.

Notes from your conversations are documented in your hospital record, this is separate to your baby’s medical notes. A brief record of contact is made in your baby’s medical notes to the clinical team are aware the psychologist has met you.

The decision to use the psychology service is entirely up to you. If you decide not to, it will not affect your baby’s care.

This page on the North Bristol NHS Trust website has links to many organisations who provide support and information to parents of babies in the neonatal unit: NICU Useful Links | North Bristol NHS Trust

South West Neonatal Network 

The South West Neonatal Network have put together virtual tours of the neonatal units in the area as well as the ambulances that transfer neonatal babies in the region. You may find this useful to look at before your first visit: SW Neonatal Units — South West Neonatal Network

You can contact our team Monday to Friday (excluding bank holidays) 09:00 to 16:00 on 0117 414 6818. 

You can ask any of your baby’s care team to contact us on your behalf and they will be happy to help. 

We hope you are pleased with the psychological service you receive.  

Our service is continually developing and reviewing our practice so we can ensure families receive the best support possible. 

When your support from our service comes to an end, you may be asked if you are happy to be contacted for your feedback and views on how the services can be improved. 

If you have concerns about the service you receive from the psychologist, please discuss them with the psychologist or another member of the NICU team. 

If this does not address your concerns, please contact the Patient Experience Team on 0117 414 4569 or email pals@nbt.nhs.uk. 

• Drinks and snacks are provided throughout the day and a lunchtime sandwich, but you can bring your own refreshments if you prefer.
• Something to keep you occupied like a newspaper or book. Wi-fi is available and you can bring your own laptop. We have portable DVD players and a selection of DVDs to use in the department.
• Some patients like to have a family member or friend with them during their treatment; this is entirely up to you.

Depending on what treatment you have, drips may be given through a cannula in the back of your hand or you may be advised to have a PICC (peripherally inserted central catheter) placed in your arm. This is a thin tube which stays in place for the duration of your treatment. This can be used to give medication and take blood tests.

Some treatments are given by sub-cutaneous (under the skin) injections.

Before starting each cycle of treatment, you will be seen by a doctor or senior nurse. You will also be asked to give a blood sample and have your blood pressure and temperature checked. This is a good opportunity to discuss any problems or side-effects you are concerned about.

The pre-assessment will help to decide whether you are fit enough to start the next cycle and whether any adjustments are needed.

Your treatment should not be painful. If you are feeling pain let a member of staff know immediately.

Your disease and the treatment can make you more vulnerable to infection. Neutrophils are white blood cells that fight off infections and if you don’t have enough of them then you are much more vulnerable to catching infections and becoming unwell. Your neutrophil count is a good indicator of how vulnerable you are.

A normal neutrophil count is between 1.5 and 8.0 x 10⁹/L. A neutrophil count that is below 1.0 x 10⁹/L is particularly dangerous. If you have an infection (we call this neutropenia).

Usually, the neutrophil count drops about 7-10 days after having chemotherapy. It is safe to be at home with a low count as long as you do not have any symptoms of infection, but it is a good idea to be extra careful, avoiding people with coughs, colds and infections as well as large gatherings of people. For example, the theatre, supermarkets, and restaurants for the duration of your treatment.

Handwashing is an important infection prevention measure, before and after going to the bathroom, handling food or rubbish. Before eating is probably the most important thing you can do to avoid picking up infections.

We will take extra precautions if you are in hospital and if your count is less than 1.0 x 10⁹/L.

Neutropenic sepsis means that you have an infection when your white blood cells are too low. This is a life-threatening emergency. Call for help immediately if you have recently had treatment or if you have been told that your condition puts you at risk and you become unwell with any of the following symptoms:

• Temperature – Above 37.5°C or below 36°C.
• Uncontrollable shivering/shaking (rigor).
• Other signs of infection for example sore throat, cough, diarrhoea or vomiting that last for more than 24 hours, pain, burning or difficulty passing urine.
• Pain, swelling, or redness at the site of your PICC line, if you have one.
• Suddenly feeling unwell, even with a normal temperature.

Use the numbers on your Chemo Alert card (also on the back of this leaflet to speak to a nurse straight away.

Depending on the reason for you calling, you may be asked to contact your GP or come to a specific department in the hospital.

If you cannot get hold of us on the numbers on your chemo alert card and you think you have an infection, go to the nearest A&E. (You may need to phone 999 for an ambulance if you don’t have transport and feel too unwell to drive).

• Please do not attempt to come to the Haematology Department or Chemotherapy Suite without an appointment as this may lead to a delay in getting the attention you need.
• If you are admitted to hospital with a possible infection, you need to receive an intravenous dose of antibiotics within one hour of arriving. Please show your Chemo Alert card to staff and make sure they are aware of this.

Not all anti-cancer treatment causes nausea and vomiting. If your treatment is expected to cause nausea, we will give you anti-sickness medication. We will explain the best way to take them.

If you are unsure how to use them or if they are not controlling your symptoms, please contact us.

Not all treatment causes hair loss. Your CNS or chemotherapy nurse will be able to advise you about this. If you would like to be referred for a wig, they can organise this for you.

There will be a charge for your wig. This may be reduced if you are receiving certain benefits.

If you lose your hair, it grows back after treatment has finished but can be different in colour or texture than before.

Some cancer treatments can affect your ability to become pregnant or father a child. Options for fertility preservation will be discussed with you if this is a concern.

Many medicines can harm unborn babies and you may need to take precautions to reduce this risk. In some cases, this will be discussed with you specifically. Please ask if you have any concerns.

A cancer diagnosis can cause many different feelings and emotions. People react in different ways and there is no right or wrong way to feel.

If you are feeling overwhelmed and/or distressed, please feel free to speak to any of the Haematology team about your concerns.

Whether you continue to work or not throughout treatment will depend on you, your job, and the environment you work in. Please discuss this with your nurse or consultant.

We are happy to support you in letting your employer know what is going on and helping you access financial support and advice.

You do not have to inform the DVLA that you have cancer or are having treatment. We recommend that you do not drive to your first treatment session as it is difficult to know how you may be affected. For example, some medicines can make you feel drowsy. If you are feeling at all unsafe then do not drive. In some cases, we can offer hospital transport to and from hospital.

If you are receiving treatment at North Bristol NHS Trust, you are entitled to a free car parking pass. This is valid for up to 3 months and is renewable for as long as you need it. Please ask the CNS or chemotherapy staff for details.

Exercise means different things to different people. Research has shown that some gentle exercise has been beneficial to patients undergoing treatment. However, this does depend on how you feel. It is important to not push yourself too much.

If you feel tired or fatigued, it is important to rest. However sometimes getting out for some fresh air or to walk the dog can be just as beneficial. We can refer you to a physiotherapist if you need help dealing with fatigue or returning to normal activity levels.

We usually recommend that you do not travel abroad during treatment. Your doctor can advise you about having a holiday within the UK. If your blood counts are satisfactory and you feel well, you may benefit from a short break within the UK. It is important that your life is not completely put on hold during this difficult time.

If you become unwell when you are away from home do not attempt to return to Bristol before seeking help. Please go to the nearest hospital with an emergency department. Take your chemotherapy alert card with you and provide as much information as you can about your diagnosis and the treatment you are having.

Living with cancer can have a significant impact on your income and the cost of living. There is a team of benefits advisors provided by Macmillan and the Citizens Advice Bureau. Talk to your CNS or the team at the Macmillan Wellbeing Centre and ask to be referred.

You may also be able to apply for a grant from Macmillan to help with the cost of living with a cancer diagnosis.

If you have a cancer diagnosis you are entitled to free NHS prescriptions. If you do not already have exemption from prescription charges, please ask the CNS about this.

Everybody with a cancer diagnosis has access to a specialist nurse or Macmillan nurse.

The nurse is here to provide you and your family with the support and information you need before, during, and after your treatment. For most people with a haematological cancer the CNS will be your ‘Key Worker’ and your point of contact with the Multi-Disciplinary Team responsible for your care.,

You should see the CNS before you start your treatment. Whenever possible this will happen in the outpatient clinic or Medical Day Unit at the same time as another appointment.

Our CNSs work Monday to Friday from 09:00 to 17:00 and can be contacted by phone or email. Please be prepared to leave a message when you call.

Phone: 07545 421893

Email: haematologyCNS@nbt.nhs.uk

The Acute Oncology Nurses work Monday-Friday, 08:00-16:30, and you can phone them 07860 783116.

The Acute Oncology Service provides specialist advice and support for cancer patients with urgent problems related to their illness or treatment.

They can advise the best thing to do, whether this is to attend hospital or your GP for assessment.

Cancer Support Workers work with the Clinical Nurse Specialist team and cancer team. They provide support and advice to patients at the time of diagnosis, during, and after treatment.

They are trained to provide support and information about physical, emotional, and practical concerns to help you self-manage your recovery and return to a healthy lifestyle as soon as possible.

Support is provided face to face, over the phone, or by email.

The Wellbeing Centre is located opposite the main hospital entrance at the end of the car park, next to the Breast Care Centre. We offer help and information about different kinds of cancers and treatments. We also talk about, finances and benefits, diet, exercise, and emotional support. We are here to listen to you and the people who support you.

The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 08:30 to 16:15

Phone: 0117 414 7051

Blood Cancer UK

Information and support for everyone affected by all blood cancers. Leukaemia, lymphoma, myeloma, MDS, MPN.
Blood Cancer UK | We're here to beat blood cancer
Phone: 0808 2080 888

Cancer Research UK

Information service about cancer and cancer care for people with cancer and their families.
Cancer Research UK
Phone: 0808 800 4040

Leukaemia Care

Information and support for people living with leukaemia, MDS and MPNs
Leukaemia Care - The UK's leading leukaemia charity
Phone: 0808 801 0444

Lymphoma Action

The UK's only charity dedicated to lymphoma.
Lymphoma Action
Helpline: 0808 808 5555

Macmillan Cancer Support

Offers a range of support for the emotional and practical impacts of living with cancer.
Macmillan Cancer Support | The UK's leading cancer care charity
Support Line: 0808 808 0000

MDS UK Patient Support Group

Supports anyone affected by MDS or CMML. Providing reliable information and support.
Home | MDS UK Patient Support Group
Phone: 020 7733 7558

MPN Voice

MPN Voice’s mission is to provide clear and accurate information and emotional support to everyone who has been diagnosed with a myeloproliferative neoplasm (MPN) and their families/friends.
MPN Voice – mpnvoice.org.uk
Phone: 07934 689 354

Myeloma UK

Provides information and support to anyone affected by myeloma. Offers support groups, discussion forums and Infoline. Includes related disorders including AL amyloidosis, Monoclonal Gammopathy of Undetermined Significance (MGUS) and Plasmacytoma.
Homepage - Myeloma UK
Info line: 0800 980 3332

Penny Brohn

Health and wellbeing support for people living with cancer.
Penny Brohn UK – Cancer wellbeing for everyone
Phone: 0303 3000 118

NHS website

Offers general health information
NHS website for England - NHS

Haemotology Clinical Nurse Specialists

Monday-Friday, 09:00-17:00
07545 421 893

Acute Oncology Nurse

Monday-Friday, 08:30-16:00
07860 783 116

Chemotherapy Suite

Monday-Friday, 09:00-17:00
0117 414 3580

Clinical Hub (out of hours)

0117 414 0700

• Write down your most important questions.
• List or bring all your medicines and pills – including vitamins and supplements.
• Write down details of your symptoms, including when they started and what makes them better or worse.
• Ask your CNS team for an interpreter or communication support if needed.
• Ask a friend or family member to come with you, if you like. 

• Don't be afraid to ask if you don't understand. For example, 'can you say that again? I still don't understand.'?
• If you don't understand any words, ask for them to be written down and explained.
• Write things down or ask a family member or friend to take notes.

Ideas of questions to ask at the time of your appointment

• 'what's happening if I'm not sent my appointment details,' and 'can I have the results of any tests?'
• If you don't get the results when you expect – ask for them.
• Ask what the results mean.

Before you leave your appointment

• Ask who to contact if you have any more problems or questions.
• About support groups and where to go for reliable information. 

• Write down what you discussed and what happens next.
• Keep your notes.

• What are the tests for?
• How and when will I get the results?
• Who do I contact if I don't get the results? 

• What happens next?
• Do I need to come and see you?
• Who do I contact if things get worse?
• Do you have and written information?
• Where can I go for more information?
• Are there any support groups or other sources of help?