Bone Marrow Biopsy

(Biopsy-Bone Marrow, Bone Marrow Aspiration and Biopsy)

Procedure overview

What is a bone marrow biopsy?

In the center of most large bones there is a soft tissue (called bone marrow) that makes about 95 percent of the body's blood cells. The marrow is a network of tissue that contains immature blood cells in an organized structure. 

Red bone marrow is the active portion that produces red blood cells, while yellow bone marrow contains fat cells. In adults the red bone marrow is located in the flat bones, such as the upper hip bones, known as the pelvic girdle, and the sternum. In children, the red bone marrow is in the long bones, such as the femur.

A bone marrow biopsy involves removing tissue from the red bone marrow to be sent to the lab for microscopic examination. The biopsy is done using a small needle inserted into an age appropriate area (long bone for children, flat bone for adults). A local anesthetic agent may be given before starting the procedure.

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Reasons for the procedure

A bone marrow biopsy is usually performed if your doctor suspects that you have a problem with blood cell production. A pathologist in the lab examines blood and bone marrow samples. By using a microscope with special lab techniques, the pathologist can evaluate the bone marrow for any of the following:

• Unexplained anemia (a decrease in the number of red blood cells)
• Abnormal numbers of blood cells (red blood cells, white blood cells, or platelets)
• Bleeding or clotting disorders (such as hemophilia)
• Iron deficiency
• Inherited blood disorders (such as thalassemia or sickle cell disease)
• Leukemia (a cancer of the blood-forming tissue)
• Cancers that have spread to the bone marrow
• Response to chemotherapy

There may be other reasons for your doctor to recommend a bone marrow biopsy.

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• Bruising and discomfort at the biopsy site
• Prolonged bleeding from the biopsy site
• Infection near the biopsy site

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
• You may be asked to fast for several hours prior to the procedure.
• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A bone marrow biopsy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

A bone marrow biopsy is commonly done using the pelvis (iliac crest), but another bone (such as the breastbone) may be used. In a child, a leg bone or vertebra (bone in the spine) may be used.

Generally, a bone marrow biopsy follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
2. Your position may vary depending on the bone that is used. If the pelvis is used, you may be asked to lie on your side or your stomach.
3. During the procedure, you will need to lie as still as possible.
4. The skin over the biopsy site will be cleansed with an antiseptic solution.
5. As the doctor injects a local anesthetic to numb the area, you will feel a needle stick and a brief stinging sensation.
6. A small incision may be made over the biopsy site and the biopsy needle will be inserted through the surface of the bone and into the middle of the bone (bone marrow).
7. A bone marrow aspiration is usually performed first. The doctor will use a syringe to pull a small liquid sample of the bone marrow cells through the needle. It is common to feel pressure as the needle is pressed into the bone, and a pulling sensation when the marrow is removed.
8. The doctor will remove a small, solid piece of bone marrow, called a core biopsy, using a special hollow needle.
9. The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site for a few minutes, until the bleeding has stopped.
10. A sterile bandage or dressing will be applied.
11. The bone marrow samples will be sent to the lab for examination.

After the procedure

Once you are home, it is important for you to keep the biopsy area clean and dry. Your doctor will give you specific bathing instructions. Leave the bandage in place for as long as instructed by your doctor (usually until the next day).

The biopsy site may be tender or sore for several days after the bone marrow biopsy. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your doctor to report any of the following:

• Fever
• Redness, swelling, bleeding, or other drainage from the biopsy site
• Increased pain around the biopsy site

You may resume your usual diet and activities unless your doctor advises you differently.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.