Bone marrow aspiration and biopsy

Bone marrow is the soft, spongy tissue inside most bones. Immature blood cells develop into red blood cells, white blood cells and platelets in the bone marrow.

A bone marrow aspiration removes a small amount of fluid and cells from the bone marrow.

A bone marrow biopsy removes a small amount of bone along with fluid and cells from the bone marrow.

A bone marrow aspiration and biopsy are usually done together. The fluid, cells and bone removed during these procedures are examined under a microscope.

A bone marrow aspiration and biopsy are done to check the health of the bone marrow. They may also be done to:

• check that the bone marrow is making the normal number of blood cells
• find out why blood cell counts are abnormal
• diagnose blood or bone marrow cancer
• diagnose blood disorders or conditions that affect the bone marrow
• look for an infection that has started in or spread to the bone marrow
• find out if cancer from another part of the body has spread to the bone marrow
• check if treatment for a bone marrow condition or cancer is working
• collect a sample of bone marrow for a procedure such as a stem cell transplant

A bone marrow aspiration and biopsy are done by a doctor or nurse practitioner in a clinic or hospital. They usually take 20 to 30 minutes. The bone marrow aspiration is usually done first, followed by the bone marrow biopsy. Most people can go home after they are done.

A bone marrow aspiration may be taken from different parts of the body, depending on your age. In adults, the sample is usually taken from the top of a hip bone (called the iliac crest) or sometimes from the breast bone (called the sternum). In babies and young children, the sample may be taken from the front of the leg bone below the knee (called the tibia).

A bone marrow biopsy is always taken from the hip bone.

You will lie on a table or bed. The healthcare team may give you medicine to help you relax. An antiseptic solution is used to clean the area of skin where the needle will be inserted. A sterile drape is placed around the area, leaving only a small area of skin showing. A local anesthetic is used to numb the area. You may feel some burning or stinging when the anesthetic is injected.

For the bone marrow aspiration, a special needle is passed through the skin and bone into the bone marrow. A syringe is then attached to the special needle and a small amount of bone marrow fluid, which looks like blood, is removed. You may feel pain for a few seconds. Sometimes, several aspirations are taken for different tests.

For the bone marrow biopsy, a special needle that twists into the bone is used. The needle removes a small piece of solid bone tissue and marrow. You will feel pressure when the needle passes into the bone, and as the needle and tissue are being removed.

The samples are sent to a lab to be looked at under a microscope.

After the procedures are done, the area is cleaned and pressure is applied with a bandage for a few minutes to stop the bleeding. You will stay lying down for 20 to 30 more minutes. Then you can leave the clinic or hospital and go back to your normal activities.

A bone marrow aspiration and biopsy usually don’t cause serious problems. Tell your healthcare team if you have side effects that you think are from the bone marrow aspiration and biopsy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Some people may have the following side effects where the needle was inserted:

• tenderness or pain
• bleeding or bruising
• redness or swelling

A bone marrow aspiration and biopsy can show if:

• you have a certain type of cancer, such as leukemia, multiple myeloma, non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma
• cancer has spread to the bone marrow
• you have anemia or another blood disorder

These procedures can also tell the healthcare team whether or not bacteria or fungi have caused an infection in the bone marrow.

Your doctor will decide if you need more tests, procedures, follow-up care or additional treatments.

Preparing children before a test or procedure can lower anxiety, increase cooperation and help them develop coping skills. Preparation includes explaining to children what will happen during the test, including what they will see, feel and hear.

Most children will be given a general anesthetic before a bone marrow aspiration and biopsy. It is given through an intravenous (IV) line placed in a vein in the child’s hand.

Sometimes an older child can have a local anesthetic and a sedative. The healthcare team will put a numbing cream on the biopsy area before the test begins.

How you prepare your child for a bone marrow aspiration and biopsy depends on your child’s age and experience. Find out more about helping your child cope with tests and treatments.