Treatment is delivered at Hollywood Private Hospital, either in the Day Unit (Leslie Starcevich ward) or inpatient setting (Donaldson or Gosse ward), depending on your condition and therapy required. You may be required to pay your health fund excess, typically once per calendar year.

Additional tests may be required during your care, including:

• Blood tests (pathology)
• Imaging (CT, PET, MRI)
• Biopsies (lymph node, bone marrow, other)
• Other specialist investigations

These are provided by external services and may involve separate out-of-pocket costs.

What is a bone marrow biopsy?

A bone marrow biopsy is a procedure used to examine the cells inside your bone marrow (the soft tissue inside bones where blood cells
are made). The procedure involves taking:

• a small sample of liquid bone marrow (bone marrow aspirate), and
• a small core of bone (trephine biopsy).

The samples are examined in the laboratory to help diagnose or monitor blood disorders and blood cancers.

Why is a bone marrow biopsy performed?

• Investigate abnormal blood counts
• Diagnose blood cancers such as lymphoma, leukaemia or myeloma
• Determine the stage or extent of disease
• Monitor response to treatment
• Assess unexplained fevers, enlarged lymph nodes or other abnormalities.

Before your procedure

You may have a light breakfast up to 1 hour before the procedure unless instructed otherwise.

Please inform staff if you:

• take blood thinners
• have allergies
• have had reactions to sedation previously
• are pregnant or may be pregnant.

If sedation or Penthrox is used, you must:

• arrange for a responsible adult to take you home
• avoid driving, operating machinery or signing important documents for the remainder of the day.

What happens during the procedure?

The procedure usually takes approximately 15–20 minutes. The biopsy is usually taken from the back of the pelvic bone. You will lie on your side while:

• the skin is cleaned with antiseptic solution
• local anaesthetic is injected to numb the area
• a small incision is made in the skin.

Bone marrow aspirate:

A needle is inserted into the bone marrow and a liquid sample is withdrawn. Most patients experience a brief sharp pressure or pulling sensation lasting a few seconds during this part of the procedure.

Trephine biopsy:

A small core of bone marrow tissue is then collected from the same area. You may feel pressure or discomfort, although local anaesthetic and pain relief medications usually reduce this substantially. Some patients also receive:

• • Penthrox (methoxyflurane) – an inhaled pain-relieving medication
  • light sedation if required.

Your vital signs will be monitored throughout the procedure.

Risks and possible side effects

Bone marrow biopsy is generally a safe procedure. Common side effects include:

• soreness or bruising at the biopsy site
• mild bleeding
• temporary discomfort when walking or sitting.

Less common risks include:

• infection
• significant bleeding
• reaction to sedation or medications.

Please contact our rooms or seek medical attention if you develop:

• fevers
• increasing redness or swelling
• persistent bleeding
• severe or worsening pain.

After the procedure

You will usually be observed for approximately one hour after the biopsy. A waterproof dressing will be applied.

Wound care

• Keep the dressing dry and in place for 48 hours.
• You may shower if the dressing remains intact.
• Avoid strenuous activity for 24 hours.

Pain relief

Mild discomfort is common for a few days. If required, you may take paracetamol (maximum 8 tablets in 24 hours). Avoid anti-inflammatory medications unless advised otherwise.

Results

The samples are examined under the microscope and may undergo additional specialised testing. Results are usually discussed in detail at your follow-up appointment to ensure appropriate explanation and planning. Results are not routinely provided over the phone.

What is iron deficiency?

Iron deficiency is a common condition that can cause:

• tiredness and fatigue
• reduced exercise tolerance
• shortness of breath
• poor concentration
• dizziness or headaches.

Iron deficiency may occur for many reasons, including:

• blood loss
• heavy menstrual bleeding
• gastrointestinal conditions
• dietary deficiency
• impaired absorption of iron.

It is important that the underlying cause of iron deficiency is identified and treated where possible.

Why might I need an iron infusion?

Iron infusions are usually recommended when:

• iron tablets are not tolerated
• iron tablets are ineffective
• iron levels need to be replaced quickly
• there are problems absorbing iron from the gut.

An iron infusion delivers iron directly into the bloodstream through a vein.

What happens during the infusion?

Your infusion will usually be performed in the day unit or ward of a private hospital under the supervision of experienced nursing and medical staff.

After admission:

• a small intravenous cannula will be inserted into a vein in your arm
• the iron infusion will then be administered through the drip.

The infusion itself usually takes approximately 15–30 minutes, although your total stay in the unit may be longer for preparation and observation.

Most patients are able to drive after the procedure, although some people may experience temporary fatigue, headache or dizziness afterward.

Risks and possible side effects

Iron infusions are generally very safe.

Common side effects:

Some patients may experience:

• headache
• muscle or joint aches
• nausea
• flushing
• dizziness
• mild rash.

These symptoms are usually temporary and improve over several days. Approximately 1 in 3 patients experience mild muscle aches or fatigue after treatment. Paracetamol may help if required.

Less common risks:

Less common complications include:

• skin staining if iron leaks outside the vein
• low blood pressure during the infusion
• allergic reactions.

Severe allergic reactions (anaphylaxis) are very rare, occurring in approximately 1 in 30,000 patients. Staff are trained to recognise and manage these reactions immediately if they occur.

After your infusion

Most patients begin to notice improvement in symptoms within days to weeks after treatment.

You should:

• drink plenty of fluids afterward
• avoid strenuous exercise for the remainder of the day if feeling unwell
• continue follow-up blood tests as advised.

Unless otherwise advised by your doctor, you should stop taking oral iron tablets after your infusion.

Some patients may require:

• repeat blood tests
• additional iron infusions
• further investigation into the cause of iron deficiency.

Professional fees

As there is currently no Medicare rebate item for iron infusion supervision, a private professional fee applies for medical oversight of the infusion. Hospital admission fees and any additional charges are determined separately by your health fund and level of hospital cover. Please contact our rooms prior to your admission if you would like further information regarding current fees.

When should I seek medical attention?

Please contact our rooms or seek medical attention if you develop:

• worsening shortness of breath
• chest pain
• severe rash
• significant swelling
• feverspersistent dizziness or fainting.

• Please allow 10-15 minutes before your appointment time to allow for parking and if it is your first appointment, new patient paperwork (if not done beforehand)
• If you are unable to attend, notify us as early as possible. Cancellations with less than 24 hours notice will incur a cancellation fee.
• If you are currently receiving treatment and have questions about your hospital bookings, treatment side effects or are unwell:
  • Clinical Nurse Specialist (business hours) on 0461 585 451
  • Donaldson ward (after hours) 9346 6943
  • Emergencies Hollywood emergency department (24/7)