What is a Bone Marrow Biopsy?

The bone marrow is the soft, spongy tissue inside most large bones. The bone marrow produces the body’s blood cells, including red blood cells, which carry oxygen; white blood cells, which help the body fight infection; and platelets, which play an important role in blood clotting.

A bone marrow biopsy is a procedure in which doctors remove a small tissue sample of bone marrow to diagnose certain medical conditions. A bone marrow aspiration and biopsy are often done at the same time to extract both solid and liquid bone marrow.

Please continue reading to learn more about why doctors order bone marrow tests and what the procedure involves.

Why would a doctor order a bone marrow biopsy?

A doctor may order a bone marrow examination if they suspect you have a problem with your blood and bone marrow cells. As mentioned, the bone marrow makes blood cells and contains fat cells and other tissues.

A bone marrow test is usually performed by a hematologist (specialist in blood disorders) or an oncologist (specialist in cancer treatments). The bone marrow sample (liquid and solid soft tissue) is sent to the laboratory, where a pathologist examines it for abnormal cells.

Bone marrow samples can be used to diagnose the following conditions:

The cause of unexplained anemia (low red blood cells)
Conditions involving abnormal blood cell production, such as polycythemia (abnormally high red blood cells), leukopenia (abnormally low white blood cells), and thrombocytopenia (abnormally low platelet count)
A bone marrow disorder such as myelofibrosis or myelodysplastic syndrome (a condition in which immature blood cells do not mature into healthy blood cells)
Cancers of the blood or bone marrow, such as lymphoma, leukemia, and multiple myeloma
Cancers that have spread to the bone marrow from other parts of the body.
Clotting or bleeding disorders
Unexplained fever
Hemochromatosis, a condition in which there is excess iron deposition and dysfunction of multiple organs

In addition, doctors may order a bone marrow biopsy in patients with known cancer to see how much it has grown or spread. Bone marrow biopsies are also done to monitor treatment progress. For example, to see if the bone marrow is making enough healthy blood cells after cancer treatment. A bone marrow biopsy may also be done to see if a person is a good match and potential donor for an allogeneic stem cell transplant.

What type of cancer requires a bone marrow biopsy?

A blood cancer, such as leukemia, lymphoma, or multiple myeloma, can be diagnosed with a bone marrow biopsy. The diagnosis is confirmed if the bone marrow sample shows cancer cells of a specific type.

Bone marrow tissue may also be removed and examined to diagnose cancers that have spread to the bone marrow from other organs in the body.

Bone marrow disease (rare blood cancers), such as myelofibrosis and myelodysplastic syndrome, are also diagnosed with bone marrow biopsies.

Do they put you to sleep for a bone marrow biopsy?

They do not usually put you to sleep for a bone marrow biopsy. It is typically done using local anesthesia.

What happens during a bone marrow biopsy?

Preparation

Your doctor will explain the bone marrow biopsy procedure to you and have you sign a consent form.

Make sure you give your healthcare providers a complete medical history and list of your medications before your bone marrow biopsy. Certain medications, such as blood thinners, can increase the risk of excessive bleeding after a bone marrow biopsy.

A bone marrow biopsy can be done on an outpatient basis in a doctor’s office or in a hospital setting where you may be asked to stay overnight. If you receive a sedative to relieve anxiety during the bone marrow biopsy, you may be drowsy afterward and will need someone to drive you home.

Procedure

The biopsy is usually obtained from a part of the pelvic bone called the posterior iliac crest that has bone marrow inside. Other biopsy sites include the sternum (breastbone) or, in young children, the tibia (shinbone).

At the start of the procedure, you will be asked to change into a hospital gown. If the biopsy site is your hip bone, you will lie on your side or stomach. It’s important to remain as still as possible during the procedure.

Your doctor will clean the skin at the biopsy site will an antiseptic solution. You will feel a brief sting from a needle prick when your provider injects the local anesthetic. This will help to numb the area and keep you comfortable.

Your provider will then make a small incision (cut) and insert a hollow needle through the bone into the bone marrow. A bone marrow aspiration is usually done first to extract the liquid portion, followed by solid tissue (this is called a core biopsy). You may experience a pressure or pulling sensation during this part of the procedure when the needle is pushed through bone tissue and when the marrow is pulled out.

Once the biopsy needle has been removed, your doctor will apply firm pressure over the biopsy site for a few minutes until the bleeding stops. They will then place a sterile bandage on the biopsy site.

Your bone marrow samples will be sent to the pathology lab. Your doctor will tell you when to expect the results of your medical test. This is usually within a few days after having the biopsy performed.

How painful is a bone marrow biopsy?

Many people report that the pain from their bone marrow biopsy was a dull pain, average in intensity, short-lived, and overall less than they had anticipated. In some cases, a bone marrow biopsy can be complicated and may take longer to perform, making it more painful. However, in uncomplicated cases, an experienced physician can perform a bone marrow biopsy in 10 minutes with minimal pain.

What are the risks of a bone marrow biopsy?

Complications associated with a bone marrow biopsy are extremely rare. However, a bone marrow biopsy can result in a biopsy site infection, fibrous scar tissue formation at the biopsy site, prolonged bleeding, persistent pain at the biopsy site, or an allergic reaction to the numbing medicine.

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