Bone marrow biopsy and aspiration

Bone marrow biopsy and aspiration are useful tools for cancer and many other conditions. Find out what a bone marrow biopsy is and what you can expect during the procedure.

Whether you're already receiving treatment for cancer or another condition or doctors are trying to make a diagnosis, your bone marrow has a story to tell. Bone marrow is responsible for the creation of your blood cells, and because of that, it holds a wealth of clues about your health. A bone marrow biopsy and bone marrow aspiration examine your bone marrow to look for those clues.

Bone marrow is spongy tissue found inside some of your larger bones. Bone marrow has a fluid portion and a more solid portion. Bone marrow in your breastbone, hips, ribs, skull and spine contains stem cells. These stem cells turn into white blood cells, red blood cells and platelets; they aren't the same as embryonic stem cells.

Who is a bone marrow biopsy and aspiration for?

A biopsy is a method to remove a tissue sample from your body for examination. In a bone marrow biopsy, a sample of solid bone marrow material is taken. (A bone marrow biopsy isn't the same as a bone biopsy; a bone biopsy takes a sample of actual bone.)

A bone marrow aspiration is usually done at the same time as a bone marrow biopsy. In an aspiration, a sample of the liquid portion of your marrow is withdrawn. To help visualize this, think of your bone marrow as a moist sponge. Aspiration takes the liquid from the sponge. The biopsy takes a piece of the sponge.

A bone marrow biopsy and a bone marrow aspiration offer different, but complementary information about your cells. In some cases, you may need only a biopsy or only an aspiration, not both. Together, a bone marrow biopsy and aspiration are often called a bone marrow exam.

Key information about your health
A bone marrow exam offers detailed information about the condition of your blood cells. Sometimes, collecting a blood sample through a vein in your arm provides enough information about your health. But if those results are abnormal or don't offer enough details, you may need further evaluation with an examination of your bone marrow.

Because your bone marrow is essentially a blood cell factory, it's normally rich in young cells. Examining bone marrow gives a much more detailed picture of the types, amount and condition of these newly forming blood cells.

Your doctor may want a bone marrow biopsy and aspiration done in order to:

Diagnose certain conditions
Assess the stage or progression of certain conditions
Monitor treatment of certain conditions

Bone marrow biopsy and aspiration are useful for numerous conditions. They're most often used in such conditions as:

Amyloidosis
Anemias
Hemochromatosis
Infectious diseases, such as leishmaniasis or HIV
Leukemias
Lymphomas
Multiple myeloma
Myelofibrosis
Neuroblastoma
Polycythemia vera
Thrombocythemia

If you have hemophilia, blood-clotting disorders or infections at the potential biopsy site, you may not be able to have a bone marrow exam. The procedure could cause excessive bleeding or worsen an infection.

How do you prepare for a bone marrow biopsy and aspiration?

Bone marrow exams are often performed on an outpatient basis. In some cases, though, you may already be hospitalized when you need a bone marrow exam. Because bone marrow biopsy and aspiration can be painful, you'll need some form of anesthesia to reduce the pain. You have two options:

Intravenous (IV) sedation. With this option, you're either completely or partially sedated (conscious sedation) during the bone marrow procedure.
Local anesthesia. With this option, you're fully awake during the procedure but the area to be biopsied is numbed to reduce pain.

No matter which option you choose, tell your doctor if you've ever had an allergic reaction to any type of anesthetic or have become ill after anesthesia. Also tell your health care team if you're pregnant and what medications and supplements you take.

How are a bone marrow biopsy and aspiration done?

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Bone marrow exam

A bone marrow exam can be done in the hospital, a clinic or a doctor's office. A bone marrow biopsy and aspiration are usually done by a doctor, such as a specialist in blood disorders (hematologist) or a cancer specialist (oncologist), by a nurse, or by a specially trained technologist.

A bone marrow sample is usually taken from the back of one of your hipbones, in an area called the posterior iliac crest. Aspiration is usually done at the same place. However, in some cases, the aspirate fluid can be taken from the breastbone or from the front of the iliac crest near the groin. In babies and very young children, the aspirate may be taken from the lower leg bone, just below the knee.

What can you expect during a bone marrow biopsy and aspiration?

The bone marrow exam typically takes about 30 minutes. If you have IV sedation, the procedure can take longer because of additional preparation and post-procedure care.

Bone marrow aspiration
The bone marrow aspiration is usually done before the bone marrow biopsy. For the aspiration, a hollow needle is inserted through an incision and on through the bone and into the bone marrow cavity of your iliac crest. Because local anesthetics aren't able to numb the interior of your bone, you may feel a deep, aching pain when the needle is fully inserted.

A syringe is used to draw a sample of the liquid portion of the bone marrow into the hollow needle. As the liquid is drawn up, you may feel a painful stinging, sucking or pulling sensation, which may travel down your leg. The aspiration takes only a few minutes. You may need to have several samples taken.

Your health care team checks the sample to make sure it's adequate. If it is, the needle is removed. In rare cases, a "dry tap" may occur. This is when fluid can't be withdrawn. The needle may need to be repositioned for another attempt.

Bone marrow biopsy
A different type of needle is inserted for the bone marrow biopsy. Getting this needle through the bone and into the marrow can be difficult. You may feel a lot of pressure or maneuvering as the needle is positioned properly.

A core sample of bone marrow is taken with the needle. You may feel a dull, aching pain for a moment as the sample is taken. Again, the pain may travel down your leg. You also may have a sensation of tugging or pushing, but not pain. Like the aspiration, the biopsy takes only a few minutes.

Again, your health care team checks the sample, and if it's adequate, the needle is removed.

Following the examination
After your bone marrow exam, a large pressure bandage is applied to help minimize bleeding.

If you had IV sedation, you'll be taken to a waiting area to recover from the effects of the sedation. If you're returning home after the procedure, have someone else drive you. Because the anesthesia may cause impaired judgment, memory lapses or slowed response times, you may be unable to resume all of your normal activities for another 24 hours.

If you had local anesthesia, you may have to lie on your back for at least 15 minutes to apply pressure to the biopsy site. You can then leave and go about your day, returning to normal activities as soon as you feel up to it.

Whether you had IV sedation or local anesthesia, you may feel pain or mild discomfort for a week or more after your bone marrow exam. If the pain is intolerable, ask your doctor about what kind of pain relievers you can take. You can also try to control pain without medications if you're concerned about the health risks of pain relievers. For instance, applying a cold compress to the biopsy site may reduce pain. Light exercise, such as walking, may also help.

Site care
Keep the pressure bandage on and dry for the next 24 hours. Don't take a shower or a tub bath and don't swim or use a hot tub. After 24 hours, it's OK to get the biopsy area wet and to replace the pressure bandage with a regular adhesive bandage.

A small amount of bleeding is normal. However, if bleeding soaks through the bandage or doesn't stop with direct pressure, contact your health care team as soon as possible.

Other situations in which to contact your health care team include:

Developing a persistent fever
Unrelenting or worsening pain or discomfort
Swelling at the biopsy site
Increasing redness or drainage at the biopsy site

Although you can often return to normal activities after a bone marrow exam, avoid heavy activity or exercise for the next 24 hours. This will help minimize bleeding and discomfort.

Results of a bone marrow biopsy and aspiration

The bone marrow samples are sent to a laboratory for analysis. Your health care provider generally gives you the results within a few days, but sometimes it may take longer. Ask your physician when he or she expects to receive the results of your test.

Risks of a bone marrow biopsy and aspiration

Bone marrow exams don't usually pose a big risk. Complications are rare, and those that do occur are often mild.

Risks include:

Excessive bleeding, particularly in people with a low platelet count or people taking aspirin or anticoagulants, such as warfarin
Infection, especially in people with compromised immune systems
Breaking of needles within the bone, which may cause infection or bleeding
Penetration of the breastbone (sternum) during sternal aspirations, which can cause heart or lung problems
Long-lasting pain
Complications related to IV sedation, such as an allergic reaction, nausea or irregular heartbeats

You can get through it
Just knowing that you may have a bone marrow exam can cause anxiety and stress. You may have heard from others that it's extremely painful. If you're overly anxious or worried about the pain, be sure to talk to your health care team about pain-control options.

Bone marrow exams aren't always painful, though. And usually they're over with quickly. With that in mind, along with appropriate pain and anxiety control, you can get through a bone marrow exam without too much worry.