What is Bone Marrow Biopsy?
Bone marrow is the soft tissue that is inside most large bones. Bone marrow makes a lot of the body’s blood cells, including red blood cells, white blood cells, and platelets.
Stem cells within the bone marrow produce various blood cells. There are two main types of stem cells in bone marrow called myeloid and lymphoid cells.
Myeloid cells create red blood cells, white blood cells, and platelets. Lymphoid stem cells produce a specific type of white blood cell responsible for immunity.
Blood is made of different components and plays an important role in maintaining health. Bone marrow makes these components. Red blood cells play a vital role by carrying oxygen throughout the body. White blood cells, of which there are several different kinds, are important to help the body fight infection. Platelets help stop bleeding by helping blood to clot.
A bone marrow biopsy is a medical test that helps doctors check the health of blood cells.
Why is Bone Marrow Biopsy performed?
Your doctor may order a bone marrow biopsy if your blood tests show your levels of platelets, or white or red blood cells are too high or too low. A biopsy will help determine the cause of these abnormalities, which can include:
- Anemia, or a low red blood cell count
- Bone marrow diseases, such as myelofibrosis or myelodysplastic syndrome
- Blood cell conditions, such as leukopenia, thrombocytopenia, or polycythemia
- Cancers of the bone marrow or blood, such as leukemia or lymphomas
- Hemochromatosis, a genetic disorder in which iron builds up in the blood
- Infection or fever of unknown origin
These conditions can affect your blood cell production and the levels of your blood cell types.
Your doctor may also order a bone marrow test to see how far a disease has progressed, to determine the stage of a cancer, or to monitor the effects of a treatment.
What should I know before receiving Bone Marrow Biopsy?
As with any medical test, there are potential risks to a bone marrow biopsy, as well as reasons why the test may not be recommended.
The most common side effect of a bone marrow aspiration and biopsy is bleeding. This is uncommon overall (less than 1 percent) but is more likely to occur if a person’s platelet count is low. In this case, however, the benefits of a diagnosis may still outweigh any potential risk.
Infection (due to the opening in the skin where the needle enters) may also occur, especially in people who are at a greater risk of infection due to a reduced number of white blood cells. Persistent pain after the procedure may also occur for some people. These risks can be reduced by checking a complete blood count prior to the procedure.
When a bone marrow aspiration is performed on the breastbone (sternum) there is a small risk of damage to nearby structures due to the close proximity of the heart and lungs.
There is also a small risk of side effects or an allergic reaction to the medications given to make you drowsy (or heavier sedation in children) or to the local anesthetic used to numb the site where the needle is placed.
In people who have a very low platelet count, the procedure may need to be delayed, or platelet transfusions may be given prior to the biopsy. For those who have a very low white blood cell count, the procedure may also be delayed, or medications may be given to increase counts before the test is done.
How to prepare for Bone Marrow Biopsy?
Before the bone marrow biopsy, a health provider will ask questions to ensure the safest care. Preparing a list of questions and medical history can help speed the process.
The health provider will ask about medications or herbal treatments that can increase bleeding. Bone marrow biopsies carry a risk of bleeding.
Common pain relievers such as aspirin, ibuprofen, and naproxen can also increase bleeding. Anticoagulants or blood thinners such as heparin and warfarin also are known to increase bleeding risk.
The health provider will provide instructions about whether to continue taking medications or stop them before the procedure.
Allergies are an important concern with a biopsy. The health provider will ask about allergies, especially to anesthetics and latex, which is found in surgical gloves.
Anesthetics may be used during the procedure, so patients should ask a friend or family member to drive them home.
What happens during Bone Marrow Biopsy?
How a bone marrow biopsy is carried out varies by doctor. Generally, the process takes two steps:
- Aspiration: The doctor removes fluid from the bone marrow
- Biopsy: The provider removes a tiny piece of bone and bone marrow tissue
A bone marrow biopsy is usually done on an outpatient basis, but some patients may have the procedure done while in the hospital. A bone marrow biopsy is commonly done with the pelvic bone, but other bones may be used.
The steps of a bone marrow biopsy are generally as follows:
- Before the biopsy, the patient changes into a gown. The health provider will ask the patient to lie on their side or stomach. The position may vary based on biopsy site. The provider then cleans the biopsy area with an antiseptic.
- The doctor applies an anesthetic with a needle to numb the biopsy area. There may be some pain when the needle is applied and the anesthetic is released into the area.
- Once the biopsy site is numb, the doctor makes a small incision at the biopsy site. Bone marrow aspiration is often carried out first. The doctor will use a syringe to take a liquid sample of the bone marrow cells.
- After the aspiration, the doctor carries out the bone marrow biopsy. The process involves using a larger needle than the one used during the aspiration. The doctor guides the needle into the bone, rotates it, and then removes a sample of bone and tissue.
What happens after Bone Marrow Biopsy?
Pressure will be applied to the area where the needle was inserted to stop the bleeding. Then a 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. Plan to have someone drive you home, and 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).
Wear the bandage and keep it dry for 24 hours. Don’t shower, bathe, swim or use a hot tub. After 24 hours you can get the aspiration and biopsy area wet.
Contact your doctor if you have:
- Bleeding that soaks through the bandage or doesn’t stop with direct pressure
- A persistent fever
- Worsening pain or discomfort
- Swelling at the procedure site
- Increasing redness or drainage at the procedure site
To help minimize bleeding and discomfort, avoid rigorous activity or exercise for a day or two.
If you have any questions about the Bone Marrow Biopsy, please consult with your doctor to better understand your instructions.
Explanation of results
What do my results mean?
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.
At the lab, a hematologist or a specialist in analyzing biopsies (pathologist) will evaluate the samples to determine if your bone marrow is making enough healthy blood cells and to look for abnormal cells. The information can help your doctor:
- Confirm or rule out a diagnosis
- Determine how advanced a disease is
- Evaluate whether treatment is working
Depending on your exam results, you may need follow-up tests.
Depending on the laboratory and hospital, the normal range for Bone Marrow Biopsy may vary. Please discuss with your doctor any questions you may have about your test results.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Bone marrow biopsy and aspiration. https://www.mayoclinic.org/tests-procedures/bone-marrow-biopsy/about/pac-20393117. Accessed October 9, 2018.
What Is a Bone Marrow Biopsy? https://www.healthline.com/health/bone-marrow-biopsy. Accessed October 9, 2018.
What Is a Bone Marrow Biopsy? https://www.verywellhealth.com/how-is-a-bone-marrow-test-done-2252452. Accessed October 9, 2018.
What does a bone marrow biopsy involve? https://www.medicalnewstoday.com/articles/312292.php. Accessed October 9, 2018.
Review Date: November 4, 2018 | Last Modified: September 12, 2019