In bone marrow aspiration and biopsy, a sample of bone marrowthe soft tissue that fills the cavities inside of bone where the majority of blood cells are producedis obtained and sent to a laboratory for analysis. Two techniques are employed to obtain specimens: Either a fine needle is used to withdraw (aspirate) liquid marrow and marrow fragments, or a larger needle is used to obtain a small core of marrow tissue. Both procedures may be performed consecutively at different sites to yield optimal specimens. There are 4 common sites for bone marrow aspiration and biopsy:
The preferred site is the rear upper pelvic bone (posterior iliac crest), since no major blood vessels or organs are located nearby.
A second location is the front upper pelvic bone (anterior iliac crest).
The central, flat bone at the front of the chest (sternum) is sometimes used because it is close to the surface; however, this location involves a higher risk since it is situated near the heart and major blood vessels.
The larger shin bone (tibia) is typically used in infants under 1 year of age.
Purpose of Bone Marrow Aspiration and Biopsy
- To help diagnose blood disorders, such as leukemia and myeloma (cancers originating in the bone marrow); granulomatous disorders (in which there is an accumulation of inflammatory cells in the marrow); certain types of severe anemia; leukopenia (low number of white blood cells); thrombocytopenia (decrease in blood platelets); or any combination of these
- To determine the cause of severe anemia (e.g., decreased red blood cell [RBC] production, increased RBC loss, abnormal RBC production, and/or abnormal vitamin or mineral levels).
- To evaluate the cellularity and architecture of the bone marrow
- To diagnose primary and metastatic tumors
- To obtain a specimen for culture in order to identify the cause of an infection
- To help determine the stage of cancers such as lymphomas and Hodgkin's disease (cancers primarily involving the lymph nodes)
- To evaluate the effectiveness of chemotherapy and monitor one of its major side effects, inhibition of bone marrow function (myelosuppression)
Who Performs Bone Marrow Aspiration and Biopsy
- A physician specializing in blood disorders (hematologist), a cancer specialist (oncologist), or a trained nurse
Special Concerns about Bone Marrow Aspiration and Biopsy
- This procedure is not appropriate for people taking an anticoagulant medication or those with a bleeding disorder.
Before Bone Marrow Aspiration and Biopsy
- Tell your doctor if you regularly take nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, naproxen, piroxicam, sulindac or fetoprofen) or the anticoagulants warfarin (Coumadin) or heparin. You will be instructed to discontinue them for some time before the test. Also mention any other medications, herbs, or supplements that you take.
- Anesthetic medicine will be used to prevent pain during the procedure.
- A blood sample will be obtained and coagulation studies will be performed to ensure you are a proper candidate for this procedure.
- You may request to be given a sedative medication about 1 hour before the procedure.
What You Experience during Bone Marrow Aspiration and Biopsy
- You will be positioned differently according to the selected biopsy siteeither lying down on your side or stomach (posterior or anterior iliac crest) or on your back (sternum) on a bed or examination table.
- The biopsy site is shaved (if necessary) and cleansed with an antiseptic, and a local anesthetic is injected to numb the area. (You will still feel pressure as the needle enters the bone, and a brief pain as the marrow is removed.)
- You must remain still during the procedure.
- For bone marrow aspiration, a thin needle is inserted and rotated until it penetrates the outer layer of bone. A syringe is attached to the needle and used to withdraw a small amount of marrow. The marrow slides are prepared immediately; if an adequate specimen has not been obtained, the needle is repositioned slightly and the procedure is repeated.
- For a needle biopsy—which may be performed at the same or a different site—a larger needle is inserted through a small skin incision and into the bone using a steady, boring motion. A small core of marrow is sheared off, and the needle is withdrawn.
- Each of these procedures usually takes about 10 minutes.
Risks and Complications of Bone Marrow Aspiration and Biopsy
- Minor complications include local bleeding and discomfort at the puncture site.
- Rare but serious complications include infection at the biopsy site and puncture of nearby structures or a major blood vessel.
- In some cases, the procedure does not obtain an adequate marrow specimen.
After Bone Marrow Aspiration and Biopsy
- Pressure is placed on the needle puncture site until bleeding stops. The site is cleansed again and covered with a sterile bandage.
- Unless you were given a sedative, you may leave immediately after the procedure.
- Arrange for someone to drive you home. You may experience some pain or soreness at the biopsy site, but you can resume your usual activities immediately.
- Keep the biopsy site covered and dry for several hours.
- In some cases, you may be instructed to return the following day to have the biopsy site checked by a nurse or doctor.
- You may develop swelling and bruising at the puncture site. Apply pressure and ice to reduce discomfort and inform your doctor.
- Call your doctor immediately if you develop a fever; redness, bruising, bleeding, or discharge at the biopsy site; or dizziness.
Bone Marrow Aspiration and Biopsy Results
- The marrow samples are sent to hematology and pathology laboratories for microscopic examination and other tests. If an infection is suspected, a specimen is cultured in order to identify the responsible organism. Your doctor will review the results for evidence of a blood disorder, infection, or another problem.
- If an abnormality is found and your doctor can make a definitive diagnosis, appropriate treatment will be initiated.
- If bone marrow aspiration alone fails to yield an adequate sample, a needle biopsy will be performed.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media