Bone marrow biopsy and bone marrow aspiration are procedures to collect and examine bone marrow — the spongy tissue inside some of your larger bones. Bone marrow biopsy and bone marrow aspiration can show whether your bone marrow is healthy and making normal amounts of blood cells. Doctors use bone marrow biopsy and aspiration to diagnose and monitor blood and marrow diseases, including some cancers.
Bone marrow has a fluid portion and a more solid portion. In bone marrow aspiration, your doctor uses a needle to withdraw a sample of the fluid portion. In a bone marrow biopsy, a larger needle is used to take a sample of the solid part.
Bone marrow biopsy and bone marrow aspiration are often done at the same time. Together, bone marrow biopsy and aspiration may be called a bone marrow exam.
Why it's done
Bone marrow biopsy and bone marrow aspiration offer detailed information about the condition of your bone marrow and blood cells. Your doctor may order a bone marrow exam if blood tests, such as cell counts, are abnormal or don't provide enough information about a suspected problem. Examining bone marrow gives a detailed picture of the types, amount and condition of forming blood cells.
Your doctor may perform a bone marrow exam to:
- Diagnose a disease or condition involving the bone marrow or blood cells
- Determine the stage or progression of a disease
- Check iron levels and metabolism
- Monitor treatment of a disease
Bone marrow biopsy and aspiration may be used for many conditions. These include:
- Bone marrow disorders, such as myelodysplastic syndrome and myelofibrosis
- Blood cell conditions in which too few or too many of certain types of blood cells are produced, such as leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, pancytopenia and polycythemia
- Cancers of the blood or bone marrow, including leukemias, lymphomas and multiple myeloma
- Cancers that have spread from another area, such as breast, into the bone marrow
A bone marrow biopsy and a bone marrow aspiration offer different, but complementary, information about your bone marrow cells. The two procedures are most often performed together. In some cases, you may need only an aspiration.
Bone marrow exams are safe procedures. Complications are rare but can include:
- Excessive bleeding, particularly in people with a low platelet count
- Infection, especially in people with weakened immune systems
- Long-lasting discomfort at the biopsy site
- Penetration of the breastbone (sternum) during sternal aspirations, which can cause heart or lung problems
- Complications related to sedation, such as an allergic reaction, nausea or irregular heartbeats
How you prepare
Bone marrow exams are often performed on an outpatient basis, and special preparation usually isn't needed. In preparation for your bone marrow biopsy and aspiration, you may want to:
- Tell your doctor about medications and supplements you take. Certain medications and supplements may increase your risk of bleeding after a bone marrow biopsy and aspiration. Make a list of the medications and supplements you take and discuss the list with your doctor.
- Tell your doctor if you're nervous about your procedure. Just knowing that you're going to have a bone marrow exam can cause some anxiety and stress. Keep in mind that bone marrow exams aren't always painful, and they're over with quickly. If you're feeling anxious or worried, talk to your health care team. Your doctor may give you a sedative medication before your aspiration and biopsy, in addition to a numbing agent (local anesthesia) at the site where the needle is inserted.
What you can expect
A bone marrow biopsy and aspiration can be done in a hospital, a clinic or a doctor's office. The procedures are usually done by a doctor who is a specialist in blood disorders (hematologist) or a cancer specialist (oncologist), by a nurse, or by a specially trained technologist.
The bone marrow exam typically takes about 30 minutes. If you receive intravenous (IV) sedation, extra time is needed for preparation and post-procedure care.
Before the procedure
Your health care team will check your blood pressure and heart rate. Because bone marrow aspiration and biopsy can be painful, you'll receive some form of anesthesia to keep you comfortable. For most people, local anesthesia is all that's needed. You'll be fully awake during the procedure, but the aspiration and biopsy site is numbed to reduce pain.
If you feel anxious about pain, you may be given a sedative drug through a vein (IV sedation) so that you're either completely or partially sedated during the bone marrow procedure.
The area where the doctor will insert the biopsy needle is marked and cleaned. The bone marrow fluid (aspirate) and tissue sample (biopsy) are usually collected from the top ridge of the back of a hipbone (posterior iliac crest). In some cases, aspiration can be done from the breastbone or the front of the hip near the groin. In babies and very young children, the sample may be taken from the lower leg bone, just below the knee.
You'll be asked to lie on your abdomen or side, and your body will be draped with cloth so only the exam site will be showing.
Bone marrow aspiration
The bone marrow aspiration is usually done first. The doctor makes a small incision to make it easier to insert the needle. A hollow needle is inserted through the bone and into the bone marrow.
Using a syringe attached to the needle, the doctor pulls back on the plunger to draw a sample of the liquid portion of the bone marrow into the needle. You may feel a brief sharp pain or a stinging. The aspiration takes only a few minutes. Several samples may be taken.
The health care team checks the sample to make sure it's adequate. In rare cases, a "dry tap" may occur — meaning fluid can't be withdrawn. The needle may need to be moved for another attempt.
Bone marrow biopsy
In a bone marrow biopsy, a sample of solid bone marrow tissue is taken. (A bone marrow biopsy isn't the same as a bone biopsy — a bone biopsy takes a sample of actual bone.) For a bone marrow biopsy, your doctor uses a different type of needle than is used for aspiration. The larger biopsy needle is specially designed to collect a core (cylindrical sample) of bone marrow.
After the procedure
After your bone marrow exam, pressure is applied to the area where the needle was inserted to stop the bleeding. Then a smaller bandage will be placed on the site.
If you had local anesthesia, you'll be asked to lie on your back for 10 to 15 minutes and apply pressure to the biopsy site. You can then leave and go about your day, returning to normal activity as soon as you feel up to it.
If you had IV sedation, you'll be taken to a recovery area. Because the sedative may cause impaired judgment, memory lapses or slowed response times, plan to have someone drive you home. Plan to take it easy for 24 hours.
You may feel some tenderness for a week or more after your bone marrow exam. Ask your doctor about taking a pain reliever, such as acetaminophen (Tylenol, others).
Keep the bandage on and dry for 24 hours. Don't take a shower or bath, and don't swim or use a hot tub. After 24 hours, it's OK to get the aspiration and biopsy area wet.
If bleeding soaks through the bandage or doesn't stop with direct pressure, contact your health care team. Also contact your doctor if you experience:
- A persistent fever
- Worsening pain or discomfort
- Swelling at the procedure site
- Increasing redness or drainage at the procedure site
Although you can often return to your normal activities after a bone marrow exam, avoid rigorous activity or exercise for a day or two. This will help minimize bleeding and discomfort.
The bone marrow samples are sent to a laboratory for analysis. Your doctor generally gives you the results within a few days, but it may take longer. Ask your doctor when you can expect to receive the results of your bone marrow exam.
At the lab, a pathologist or hematologist will evaluate the marrow samples to check the health of the marrow, to see if it's making enough healthy blood cells and to look for abnormal cells. Most of the time, the information can help your doctor confirm or rule out a diagnosis or find out how advanced a disease is or if treatment is working. In some cases, you may need follow-up tests.