into the port each time it is used. Tubing can be attached to the needle as needed to give medication or IV fluids. An external central line requires routine dressing changes to prevent infection and to care for the skin around the tube. The external lines also are routinely flushed with a solution to keep them working properly. You will be taught how to care for the device at home. Bone Marrow Aspiration and Biopsy A bone marrow biopsy is a test done to determine whether tumor cells are in the bone marrow. A needle is inserted through into the marrow inside a bone. Some of the bone marrow (the biopsy) and the fluid in the bone marrow (the aspirate) are collected. It usually is necessary to obtain bone marrow samples from both hip bones. Patients undergoing bone marrow aspirates and biopsies may experience pain; children are often sedated for this procedure. If your child is uncomfortable after the test, a mild pain medication such as Tylenol® may be given, but not aspirin or ibuprofen (Motrin® or Advil®). A specially trained doctor (a pathologist or hematologist) examines the bone marrow under a microscope to see if white blood cells, red blood cells, and platelets are being produced normally. The doctor also looks for any abnormal cells, such as immature blood-forming cells (blasts), which can indicate leukemia; tumor cells which can indicate a different type of cancer; or dysmorphic (abnormal-looking) cells, which can indicate a different disease. The bone marrow also is assessed for protein expression of malignant (cancer) cells, which can indicate leukemia, and chromosomal abnormalities, which can diagnose other diseases. Other tests include immune-phenotyping, cytogenetics, and fluorescent in situ hybridization (FISH). During treatment the bone marrow is checked regularly to determine response to the treatment. The number of cancer cells can be measured and will indicate if and how well the treatment is working. Tumor Biopsy A biopsy of the tumor can help your child’s healthcare team make the diagnosis and choose the proper treatment. Biopsy is routinely done by removing an enlarged lymph node or a small part of a tumor. The biopsy is usually performed by a surgeon in an operating room, but some medical centers do biopsies in the radiology department. In some cases, the biopsy sample is obtained through a needle that is guided into the lymph node or tumor (fine needle aspiration biopsy). In other cases, a surgical incision is made. Sedation is often used for biopsies. Your child’s comfort and anxiety level will always be considered in planning procedures that involve needles.
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