A bone marrow biopsy is a medical test in which a doctor requests the collection and examination of a sample of bone marrow. This is done to check if the tissue is healthy and blood cell production is normal.

In the procedure, a healthcare provider inserts a small needle into a large bone, drawing a sample of the bone marrow into the needle. Then, a laboratory technician analyzes the sample for a range of diseases, including several cancers.

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

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A bone marrow biopsy can help identify the causes of issues with blood cell production.

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

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.

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

Myeloid cells create red blood cells, white blood cells, and platelets. Lymphoid cells produce a specific type of white blood cell that is responsible for immunity.

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.

A bone marrow biopsy procedure takes place a doctor's office, hospital, or clinic. A person is likely to be at the appointment for around 30 to 45 minutes in total, with the biopsy itself taking around 10 minutes.

Before the procedure

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The doctor will ask a range of questions to make sure the procedure is safe to perform.

Before the bone marrow biopsy, a doctor or other healthcare provider 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 or herbal treatments a person might be taking that could increase this risk, including common pain relievers, such as aspirin, ibuprofen, and naproxen. Anticoagulants or blood thinners may also lead to excessive bleeding.

The doctor or healthcare provider will advise on whether to continue taking medications or stop the course before the procedure.

Allergies are also an important concern when having a biopsy. The healthcare provider 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 provider removes fluid from the bone marrow.
  • Biopsy: The healthcare provider 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 usually as follows:

  1. Before the biopsy, the person under examination changes into a gown. The healthcare provider will ask them to lie on their side or stomach. The position may vary according to the site of the biopsy. The medical professional then cleans the biopsy area with an antiseptic.
  2. The healthcare provider 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 provider 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. After the aspiration comes the bone marrow biopsy. A biopsy needle is larger than an aspiration needle. The healthcare provider 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.

Studies have identified ways to make bone marrow biopsies more comfortable. An experienced health provider can help reduce the pain. Pain control medications, such as lidocaine and intravenous sedation, can also ease discomfort during the procedure.

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

What happens after a bone marrow biopsy?

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The healthcare provider will explain the results.

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

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

The biopsy area may be sore for several days. It is important to closely follow the treating doctor or healthcare provider's instructions about which pain relievers are safe to use. Some pain relievers, including aspirin, can increase the risk of bleeding after a bone marrow biopsy.

The carer will give instructions about keeping the area dry and when the protective bandage may come off. The bandage usually stays on for 1 to 2 days.

Watch out for physical signs that might signal an infection or complication. People should talk to their doctor if they experience any of the following:

  • fever
  • bleeding or other discharge
  • increased pain
  • any symptom that suggests an infection

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 that doctors use to extract and examine a bone marrow sample. This sample can help them diagnose a range of 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 amount of 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.

Q:

What cancers spread to the bone marrow from elsewhere?

A:

Many types of cancer can spread to the bone. The most likely ones that spread to the bone include breast, kidney, lung, prostate, and thyroid cancers.

Yamini Ranchod, PhD, MS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.