What does a bone marrow biopsy involve?

A bone marrow biopsy is a medical test that helps doctors check the health of blood cells. A health provider may do the procedure when there might be a problem with the production of blood cells. The health provider inserts a small needle into a large bone. The needle takes a sample of the bone marrow. Then, the tissue sample is sent to a lab for analysis.

What is bone marrow?

A doctor is demonstrating a bone marrow biopsy with a model pelvis.

Bone marrow produces red blood cells, white blood cells, and platelets.

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.

Why do a bone marrow biopsy?

Health providers order bone marrow biopsies when there are signs or symptoms that something is wrong with blood cell production.

Bone marrow biopsies are also used for patients with blood-related cancers to see how their treatment is working. They can be used to check the progress of chemotherapy.

There are many symptoms and medical conditions that can be diagnosed or evaluated using a bone marrow biopsy. Some of these diseases and conditions include:

  • Anemia – not having enough red blood cells
  • Abnormal bleeding or clotting
  • Cancers of blood and bone marrow, such as leukemia, lymphoma, or multiple myeloma
  • Cancers that have spread to bone marrow

The procedure may be done in a doctor’s office, hospital, or clinic. The biopsy itself takes about 10 minutes and the total time spent is around 30 to 45 minutes.

Before the procedure

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.

A doctor is in discussion with a patient.

Health providers will ask patients about their medications before a bone marrow biopsy.

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.

During the procedure

How a bone marrow biopsy is carried out varies by doctor. Generally, the process takes two steps:

  1. Aspiration: The doctor removes fluid from the bone marrow
  2. 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.

Does a bone marrow biopsy hurt?

There is usually some pain during and after the procedure. The level of pain varies among people.

Studies have identified ways to make bone marrow biopsies more comfortable. Having an experienced health provider is important to reducing pain. Pain control medications such as lidocaine and intravenous sedation can also ease pain during the procedure.

Anxiety and worrying about the procedure often make the experience more painful. People who are anxious about a bone marrow biopsy should talk to their doctor. Doctors are familiar with the different options to relieve pain or anxiety that comes with a bone marrow biopsy.

What happens after a bone marrow biopsy

The results may be ready a few days after the biopsy but can take longer. A pathologist or a doctor specializing in blood called a hematologist will analyze the samples. The health provider will then explain the results and there may be follow-up tests.

Two pharmacists standing in front of shelves of medicine.

Patients should talk about which pain relievers are fine to use after a bone marrow biopsy.

The biopsy area may be sore and could hurt for several days. Patients should follow their provider’s instructions about which pain relievers are acceptable to use. Some pain relievers including aspirin can increase the risk of bleeding.

The doctor will give instructions about keeping the area dry and when the protective bandage may be removed. The bandage usually stays on for 1 to 2 days.

There are symptoms to watch for that signal an infection or complication. Patients should talk to their health provider if experiencing the following:

  • Fever
  • Bleeding or other discharge
  • Increased pain
  • Any symptom that suggests an infection

Risks

Bone marrow biopsies are generally safe, but there is a risk of complications. Some of the more common problems can include:

  • Bruising and pain at the biopsy site
  • Prolonged bleeding from the biopsy site
  • Infection at or near the biopsy site

There may be other risks depending on the medical condition of the patient.

Alternatives

Direct examination of bone marrow is important in assessing certain blood diseases, including cancer. The doctor obtains information that is useful for choosing the right treatment. No other tests can provide such precise information.

New tools such as automated drills are under development. A clinical trial of a battery-operated drill has found it to be faster in extracting bone marrow, with patients reporting less pain

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