Bone Marrow Biopsy

What is bone marrow?

Bone marrow is the spongy material found in substantial amounts in the center of most large bones in the body. The different cells that make up blood are made in the bone marrow after birth. Prior to our birth, this activity primarily goes on in the liver and spleen. Bone marrow produces red blood cells for energy and the transportation of oxygen to the tissues, white blood cells to fight infection and support our immune systems, and platelets to help our blood clot.

During the biopsy procedure (properly called bone marrow aspiration and biopsy), the liquid portion of the marrow is sampled by aspiration, and then the solid portion of the marrow and surrounding bone are taken in the biopsy.

Why would they do a bone marrow biopsy?

• Why the procedure is performed: A bone marrow aspiration and biopsy procedure is done for many reasons.
  • The test allows the doctor to evaluate bone marrow function. It may aid in the diagnosis of low numbers of red blood cells (anemia), low numbers of white blood cells (leukopenia), or low numbers of platelets (thrombocytopenia), or an abnormal appearance of these types of blood cells.

What is a bone marrow test use to diagnose?

• The doctor can also determine the cause of some infections, diagnose tumors, determine how far a disease, such as lymphoma, has progressed or spread, and evaluate the effectiveness of chemotherapy or other bone marrow active drugs.
• Where the procedure is performed: Bone marrow aspirations and biopsies can be performed in doctor's offices, outpatient clinics, and hospitals. The procedure itself takes 10 to 20 minutes with much of that time taken both cleaning the skin over and then numbing the surface of the area to be sampled.

The patient will be asked to sign a consent form before the procedure. He or she will be notified of the alternatives as well as the potential risks and complications of this procedure.

Possible risks include these:

• Persistent bleeding and infection
• Pain during the procedure
• A reaction to the local anesthetic or sedative, if one is used

• The patient may receive instructions about not eating food or drinking liquids before the procedure if sedation is to be used for the test.
• The patient should be sure to tell the doctor about any prescription medications, over-the-counter medications, as well as herbal supplements he or she is taking.
• The patient should notify the doctor about all allergies, previous reactions to medications, if he or she has had any bleeding problems in the past, or if she is pregnant.
• Before the procedure, the patient will be asked to change into a patient gown.
• The patient's vital signs -- blood pressure, heart rate, respiratory rate, and temperature -- will be measured.
• Depending on the doctor, the patient may have an IV placed or have blood drawn.
• The patient may be given some medicine to help him or her relax.
• The patient may be asked to position him or herself on the stomach or on the side depending on the site the doctor chooses to use.

• The doctor will choose a place to withdraw bone marrow. Often this is the back of the hip bone (iliac crest of the pelvis), but it also can be done from the breastbone (sternum), lower leg bone (tibia), or backbone (vertebra).
• The chosen site will be cleaned with a special soap (iodine solution) or alcohol. After the skin is clean, sterile towels will be placed around the area. It is important the patient des not touch this area once it has become sterile.
• Local anesthetic, usually lidocaine, will be injected using a very thin needle at the site. Initially, there may be a little sting followed by a burning sensation. After a few minutes, the site will become numb. The bone marrow needle -- which is hollow, with a removable core and a sharpened end is then placed through the skin and into the bone. The patient may feel a pressure sensation.
  • For the bone marrow aspiration, a small amount of the liquid portion of the bone marrow is then pulled into a syringe. This results in a deep ache at the time of the aspiration due to the suction applied.
  • A bone marrow biopsy is then usually done using the hollow needle that is pressed with a twisting motion further down into the bone and a small, cylindrical sample of bone and marrow is taken up into the needle. This part results in more pressure and sometimes a sharp pain as the numbing medicine does not get to the inside of the bone.
• The wound site may bleed a small amount, so pressure is applied for a few minutes. A sterile bandage is then applied.

If the patient receives sedative medication, he or she will continue to feel drowsy for a while. After the local anesthetic wears off over the next few hours, the patient may have some pain at the biopsy site. The doctor will advise the patient about pain medication use.

The patient should keep the bandage on for 24 to 48 hours, and then it should be removed.

The samples taken from the bone marrow will be sent to a laboratory and the pathologist for analysis. Several tests are done including looking at the bone marrow under a microscope. The results of these tests will usually be available in a few days. The doctor will give the patient instructions for follow-up.

Call the doctor if the patient notices signs of spreading redness, continued bleeding, fever, worsening pain, or if he or she has other concerns after this procedure.

Go to a hospital's emergency department if these conditions develop:

• If bleeding will not stop with direct pressure
• If the patient sees thick, pus-like discharge from the wound
• If the patient has a persistent fever
• If the patient feels lightheaded