Bone Marrow Aspiration and Biopsy

A bone marrow aspiration and biopsy is a procedure in which a small amount of bone marrow and bone is removed for examination under a microscope. A bone marrow aspiration removes only the bone marrow (the soft, spongy tissue inside bone where blood cells are made). A bone marrow biopsy removes a small amount of bone, fluid and cells from the bone marrow.

Why a bone marrow aspiration and biopsy is done

A bone marrow aspiration and biopsy may be done to:

• find the cause of abnormal blood counts and to see if the bone marrow is making blood cells as it should be
• diagnose blood disorders or conditions that affect the bone marrow
• find infection that starts in or spreads to the bone marrow
• diagnose blood or bone marrow cancers, such as leukemia or multiple myeloma
• find out if cancer from somewhere else in the body has spread to the bone marrow (staging)
• monitor treatment for a bone marrow condition or cancer
• collect a sample of bone marrow for medical procedures, such as stem cell transplant

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How a bone marrow aspiration and biopsy is done

A bone marrow aspiration and biopsy is done in a clinic or hospital as an outpatient or inpatient procedure. It usually takes about 30 minutes.

• The person will lie on one side or the stomach on a table or bed.
• Sedation may be used to help the person relax.
• The skin around the area is cleaned with an antiseptic solution and a sterile drape is placed around the area, leaving only a small area of skin showing.
• A local anesthetic is injected where the biopsy needle will go into the skin.
  • The person may feel a burning sensation when the anesthetic is injected.
• A small cut or incision is made in the skin so the doctor can insert the bone marrow needle.
  • Where a bone marrow aspirate is taken depends on the age of the person.
    • In adults, a bone marrow aspirate is usually taken from the rear hip bone (iliac crest). It may also be taken from the breast bone (sternum).
    • In babies and young children, a bone marrow aspirate may be taken from the front of the lower leg bone (tibia), just below the knee.
  • A bone marrow biopsy is only taken from the hip bone.
• Both procedures are usually done at the same time. A bone marrow aspiration is usually done first, and then a bone marrow biopsy.
  • For a bone marrow aspiration:
    • A special needle attached to a syringe is inserted through the bone into the marrow cavity.
    • A small amount of bone marrow is withdrawn. This sample looks like blood.
    • The person may feel pain, but it lasts only a few seconds.
  • For a bone marrow biopsy:
    • A small core of solid bone tissue and marrow is usually removed using a special needle that twists into the bone.
    • Pressure is felt when the biopsy needle is inserted and it can be painful when cells are pulled into the syringe.
• The needle is removed and the spot is cleaned with alcohol and a bandage is put on the area.
  • Pressure is applied to the area for about 5 minutes to stop the bleeding.
  • The place where the needle went in may bleed or bruise.
  • The person may feel sore for a couple of days after the test.
  • Medication may be given to keep the person comfortable.
• The marrow samples are placed on glass slides or in specimen containers. They are sent to the laboratory to be examined under a microscope by a pathologist (a doctor who specializes in the causes and nature of disease) or hematologist (blood specialist).

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Potential side effects

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

• pain
• infection of test site
  • redness and feeling of warmth in the area
• bleeding under the skin where the needle was placed
• side effects of general anesthetic
  • nausea
  • headache
  • sore throat
  • dizziness

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What the results mean

A bone marrow aspiration and biopsy can show:

• scar tissue (myelofibrosis)
• the cause of some infectious diseases
• anemia and blood disorders
• cancers, such as leukemia or multiple myeloma
  • The type of cells and percentage of cells in the marrow are measured.
  • In particular, immature blood cells (blast cells) in the bone marrow can be measured.
    • Blast cells found in the marrow eventually turn into mature blood cells.
    • In blood-related cancers, blast cells may be very immature or the bone marrow may be producing too many blasts and not enough mature blood cells.
• cancer that may have spread to the bone marrow

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What happens if a change or abnormality is found

The doctor will decide if more tests, procedures, follow-up care or additional treatment are needed.

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Special considerations for children

Being prepared for a test or procedure can reduce anxiety, increase cooperation and help the child develop coping skills. Parents and caregivers can help prepare children by explaining to them what will happen, including what they will see, feel and hear during the bone marrow aspiration and biopsy.

• Most children will need a general anesthetic, but sometimes a local anesthetic and sedation may be used for an older child.
  • If sedation or a general anesthetic is used:
    • The child may not be allowed to eat or drink several hours before the test.
    • The child’s vital signs (heart rate, blood pressure, temperature and blood oxygen level) will be monitored throughout the procedure.
  • If a general anesthetic is used, the anesthesiologist places an intravenous (IV) line in the vein of the child’s hand.
  • If a local anesthetic is used, a numbing cream (EMLA) is placed on the biopsy area about 1 hour before the test.
• A nurse or a child life specialist may help children remain calm and talk them through the procedure.
• A parent or caregiver may stay with the child during the test.
• The child can return to school or daycare the next day after the biopsy.
• Ensure that the child avoids physical activity or sports for about a week after the test.
• Call the doctor or hospital if:
  • the test site bleeds
  • the test site oozes a lot of fluid
  • the child is not drinking fluids

The preparation you can provide for a bone marrow aspiration and biopsy depends on the age and experience of the child. See the following for more age-specific information on helping children cope with tests and treatment.

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