In a bone marrow biopsy, a doctor collects a sample of bone marrow to see if the tissue and blood cell production are healthy. A bone marrow test can help diagnose anemia, clotting disorders, and some cancers.

In this article, we explain the reasons for having a bone marrow biopsy, what it involves, and the risks.

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In a bone marrow biopsy, a healthcare professional inserts a small needle into a large bone, drawing a sample of the bone marrow into the needle. Typically, healthcare professionals remove a sample from the hip bone.

Then, a laboratory technician analyzes the sample for various diseases, including several cancers.

Learn more about cancer in our dedicated hub.

What is bone marrow?

Bone marrow is the soft tissue inside most large bones. It produces many of the body’s blood cells, including red blood cells, white blood cells, and platelets.

Different components make up blood and have vital roles in maintaining health. Bone marrow makes these components.

Red blood cells play a critical role by carrying oxygen throughout the body. White blood cells are essential for helping the body fight infection. Platelets help stop bleeding by causing blood to clot.

Myeloid and lymphoid cells, which are the two main types of stem cells within the bone marrow, produce various blood cells.

Doctors order bone marrow biopsies when signs or symptoms indicate problems with blood cell production.

Bone marrow biopsies are also used in people with blood-related cancers to monitor their treatment, for example, the progress of chemotherapy.

A bone marrow biopsy can support the diagnosis or evaluation of many symptoms and medical conditions. Some of these diseases and conditions include:

  • anemia, or a shortage of red blood cells
  • abnormal bleeding or clotting
  • bone marrow and blood cancers, such as leukemia, lymphoma, or multiple myeloma
  • cancers that have spread to the bone marrow from elsewhere
  • unexplained fevers

A bone marrow biopsy occurs in a doctor’s office, hospital, or clinic.

Before the procedure

Before the bone marrow biopsy, a doctor or other healthcare professional will ask questions to ensure the safest care. People may wish to prepare a list of questions and their medical history to speed up the process.

Bone marrow biopsies carry a risk of bleeding. The medical professional will ask about medications a person might be taking that could increase this risk. Anticoagulants or blood thinners may also lead to excessive bleeding.

Allergies are also an important concern when having a biopsy. The healthcare professional will ask about any allergies someone may have, especially to anesthetics and latex.

A doctor may use an anesthetic during the procedure to numb the pain. People receiving anesthesia may need a friend or family member to drive them home afterward.

During the procedure

A bone marrow biopsy typically involves two steps:

  • Aspiration: The healthcare professional removes fluid from the bone marrow.
  • Biopsy: The healthcare professional removes a tiny piece of bone and bone marrow tissue.

A bone marrow biopsy usually takes place on an outpatient basis. However, some people may have the procedure done while staying in a hospital.

The pelvic bone is the most common site for a marrow biopsy, but a doctor might use other bones.

The steps of a bone marrow biopsy are typically as follows:

  1. Before the biopsy, the person under examination changes into a gown. The healthcare professional will ask them to lie on their side or stomach. The position may vary according to the site of the biopsy. The medical professionals then clean the biopsy area with an antiseptic.
  2. The healthcare professional applies an anesthetic with a needle to numb the biopsy area. Some pain might occur when the needle penetrates the skin, and the anesthetic enters the area.
  3. Once the biopsy site is numb, the healthcare professional makes a small incision at the biopsy site. Bone marrow aspiration usually takes place first. The medical professional will use a syringe to take a liquid sample of the bone marrow cells.
  4. Following aspiration, healthcare professionals perform a bone marrow biopsy. A biopsy needle is larger than an aspiration needle. The healthcare professional guides the needle into the bone, rotates it and removes a sample of bone and tissue.

Does a bone marrow biopsy hurt?

People will usually experience some pain both during and after the procedure. The level of pain varies between individuals.

Anxiety and worry about the procedure often make the experience more painful. People anxious about a bone marrow biopsy should talk with their doctor.

The results may be ready a few days after the biopsy, but it might take longer. A pathologist or hematologist, or doctor specializing in blood, will analyze the samples.

Healthcare professionals use bone marrow biopsies to assess blood cell production and investigate diseases. Different biopsy results can indicate several different conditions.


The presence of cancer cells in bone marrow can confirm cancer has developed or spread to the bone marrow.

Blood cell imbalances

Doctors can assess whether a person has too many or too few specific blood cells. Distortions in these levels can indicate many conditions, such as thrombocytopenia and thrombocytosis. l

A bone marrow biopsy may reveal whether a blood cell production dysfunction is causing anemia.

The health provider will then explain the results and possibly arrange follow-up tests.

Bone marrow biopsies are usually safe, but the procedure carries 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

If a person has other health problems while having a bone marrow biopsy, this might also increase the risk of complications.

A bone marrow biopsy is a quick procedure doctors use to extract and examine a bone marrow sample. This sample can help them diagnose various blood diseases, including certain cancers.

The procedure often causes pain, but this pain is manageable in the correct, medically guided way.

The procedure presents a small risk, especially for people on blood-thinning medication. However, it is the only way to obtain precise enough information about some serious causes of abnormal blood cell production.