Test Overview

A bone marrow
biopsy removes a small amount of bone and a small
amount of fluid and cells from inside the bone (bone marrow). A
bone marrow aspiration removes only the marrow. These tests are often done to
find the reason for many blood disorders and may be used to find out if cancer
or infection has spread to the bone marrow.

  • Bone marrow aspiration
    removes a small amount of bone marrow fluid and cells through a needle put into
    a bone. The bone marrow fluid and cells are checked for problems with any of
    the blood cells made in the bone marrow. Cells can be checked for chromosome
    problems. Cultures can also be done to look for infection.
  • A bone marrow biopsy removes bone with the
    marrow inside to look at under a microscope. The aspiration (taking fluid) is
    usually done first, and then the biopsy.

A bone marrow aspiration can also be done to collect bone
marrow for medical procedures, such as
stem cell transplant or
chromosomal analysis. For a stem cell transplant, bone
marrow aspiration will be done at several places on the body (generally from
the back of the pelvic bone) to remove enough bone marrow cells for the
transplant to work.

Why It Is Done

A
bone marrow aspiration, biopsy, or both are done
to:

  • Look for the cause of problems with
    red blood cells,
    white blood cells, or
    platelets in people who have conditions such as
    thrombocytopenia,
    anemia, or an abnormal white blood cell
    count.
  • Find blood disorders, such as
    leukemia, certain
    anemias, or problems that affect the bone marrow, such
    as
    multiple myeloma or
    polycythemia vera.
  • Check to see if a known cancer, such as
    Hodgkin’s lymphoma or
    non-Hodgkin’s lymphoma, has spread to the bone marrow. This is part of what is called
    staging. It is done to find out if the cancer has
    spread and how much it has spread. This helps plan cancer treatment.
  • Find infections or tumors that may start in or spread to
    the bone marrow. If you have an infection, a
    culture and sensitivity test of the bone marrow sample
    may be used to find out which
    antibiotics will work best to treat the
    infection.
  • Find the best treatment for a bone marrow problem. Once
    treatment has been started, a bone marrow aspiration and biopsy may be done to
    see if the leukemia cells are gone, which means the treatment is
    working.
  • Collect a sample of bone marrow for medical procedures,
    such as stem cell transplantation or chromosomal analysis.

How To Prepare

You will be asked to sign a consent
form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have about the need for the
aspiration or biopsy, its risks, how it will be done, or what the results may
mean. To help you understand the importance of the biopsy, fill out the
medical test information form (What is a PDF document?).

Tell your doctor if you:

Arrange for someone to drive you home after the biopsy
because you may be given a medicine (sedative) to
help you relax.

How It Is Done

A bone marrow aspiration and biopsy is
usually done by a
hematologist,
medical oncologist,
internist, or
pathologist, or by a specially trained technologist. A
laboratory technologist may also help get the sample. This biopsy may be done
in your doctor’s office or in a hospital.

You may need to take off
all or most of your clothes, depending on what part of the body the biopsy or
aspiration is taken from. If needed, you will be given a gown to use during the
biopsy.

During the test

Blood samples from a vein in your arm may be taken before
the bone marrow biopsy. In rare cases, you may be given a blood product
(clotting factor or platelets) into a vein (IV) in your arm
to prevent bleeding after the biopsy.

Adults usually have a sample
of bone marrow fluid taken from the back of the pelvic bone. In rare cases a
fluid sample is removed from the breastbone (sternum) or from the
front of the pelvic bone. Babies and young children may have the sample taken
from the front of the lower leg bone, just below the knee. A bone marrow biopsy
is only taken from the pelvic bone.

You may be given a sedative to
help you relax. You will lie either on your side or facedown on your belly
for the biopsy. It is important that you lie still in that position during the
biopsy.

The skin over the aspiration site will be cleaned
with a special solution and a medicine (local anesthetic) will be used to numb the area. Then the aspiration needle
will be put through your skin and into your bone to reach the bone marrow. You
need to lie very still while the sample is taken. The needle is then taken out.
More than one sample may be needed, possibly from more than one place on your
body, such as from both sides of the pelvic bone.

A bone marrow biopsy uses a special tool that twists
into the bone. It is normal to feel pressure at the site and hear a crunching
sound as the tool twists into the bone.

After the samples have
been taken, pressure is put on the site to stop any bleeding. A bandage is put
on the area.

How It Feels

This procedure may be painful, but only for a few seconds. You may feel a sharp sting and burn when
the anesthetic numbs your skin over the aspiration or biopsy site. You may hear
a crunching sound and feel pressure and some pain when the needle enters the
bone. During an aspiration, you
may feel a quick, shooting pain down your leg as the sample is taken.

The biopsy site may feel
stiff or sore for several days after the biopsy. You may have a bruise on the
site.

Risks

Serious problems from a bone marrow aspiration
or biopsy are not common. Problems may include:

  • Bleeding from the biopsy site. People with
    bleeding problems have a higher chance for this. If you have bleeding problems,
    pressure will be put on the biopsy site for at least 10 minutes after the
    biopsy. In rare cases, you may be given a blood product (clotting factor or
    platelets) in a vein in your arm before the biopsy to prevent bleeding after
    the biopsy.
  • Infection of skin or the bone (osteomyelitis)
    at the biopsy site.
  • Injury to your heart, a lung, or a major blood
    vessel if the sample is taken from the breastbone (sternum). This complication
    is very rare. Samples are not often taken from the breastbone, so most people
    do not have to worry about this risk.

After the biopsy

You will lie down for 30 to 60
minutes after the biopsy so the site can be checked for bleeding. If you had a sedative, you will need someone to
drive you home after the biopsy.

You may feel sore at the biopsy
site for several days. Ice packs to the site and walking can be used to help you feel better. Ask your doctor if you can take pain medicine, such
as acetaminophen (Tylenol). Be safe with medicines. Read and follow all instructions on the label.

Call your doctor immediately if you have:

  • More tenderness, pain, redness, or swelling
    at the biopsy site.
  • A fever.
  • Bleeding or drainage, such
    as pus, from the biopsy site. If you are bleeding, put pressure on the site and
    call your doctor.

Results

A
bone marrow aspiration and
biopsy removes a small amount of bone and a small
amount of fluid and cells from inside the bone (bone marrow). It is often done
to find the reason for many blood disorders and may be used to find out if
cancer or infection has spread to the bone marrow.

Biopsy results
are usually ready in 1 to 7 days. But it may take several weeks to get the results if genetic tests are done on the sample. The bone is put into a solution that breaks down its
calcium before it is stained. The bone marrow sample is often treated with
special dyes (stains) to see any changes in the blood cells more
clearly.

Bone marrow biopsy and aspiration
Normal:

The marrow has normal amounts of fat,
connective tissue, and iron. Normal numbers of both mature and immature
(growing) bone marrow cells are present.

No signs of infection are seen.

No cancer cells, such as
leukemia,
lymphoma, or
multiple myeloma, are seen.

No cancer cells have spread from other
cancer sites, such as
breast cancer.

Abnormal:

The cells in the bone marrow do not look
normal.

There are too many or too few bone marrow
cells. The bone tissue does not look normal.

Too much iron or too little iron (iron deficiency anemia) is seen in the bone marrow.

Signs of infection are seen in the bone
marrow.

Cancer cells, such as leukemia, lymphoma, or
multiple myeloma, are seen.

The bone marrow has been replaced by scar
tissue.

Normal bone marrow in one site does not mean that all
sites in the body are normal.

What Affects the Test

You may not be able to
have the test if you can’t be still during the procedure.

Sometimes not enough bone marrow fluid is collected in a
bone marrow aspiration. This is called a dry tap. If this happens, a biopsy to
obtain bone marrow tissue is usually done.

What To Think About

  • If you have an infection, a
    culture and sensitivity test of the bone marrow sample
    can be done. If the infection is caused by a bacteria or fungus, the
    sensitivity test will show which
    antibiotics will work best to treat the
    infection.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Brian Leber, MDCM, FRCPC – Hematology

Current as ofMay 3, 2017