Bone marrow biopsy

Definition

A bone marrow biopsy is the removal of soft tissue from inside bone. Bone marrow grows inside some of the larger bones in the body. It produces platelets and red and white blood cells.

Alternative Names

How the test is performed

The bone marrow biopsy may be done in the health care provider's office or in a hospital. The sample is usually taken from the hip bone. The skin is cleansed, and a local anesthetic is injected to numb the skin.

The biopsy needle is then inserted into the bone. The core of the needle is removed by rotating the needle or inserting an instrument within the needle. This forces a tiny sample of the bone marrow into the needle. The needle is then removed. Pressure is applied to the biopsy site to stop bleeding, and a bandage is applied.

An aspirate may also be performed, usually before the biopsy is taken. After the skin is anesthetized, the aspirate needle is inserted into the bone, and a syringe is used to withdraw the liquid bone marrow. If this is performed, the needle will be removed and either repositioned, or another needle may be used for the biopsy.

How to prepare for the test

Inform the health care provider if you have allergies to any medications, what medications you are taking, and if you have bleeding problems. The health care provider should also know if you are pregnant. You must sign a consent form.

How the test will feel

There will be a sharp stinging from the anesthetic injection. As the aspirate is withdrawn, there may be a brief, sharp pain. The biopsy needle may also produce a brief pain, usually more dull. Since the interior of the bone cannot be anesthetized, this test may cause some discomfort. Not all patients experience these symptoms, however.

Why the test is performed

The test is done after abnormal types or numbers of red or white blood cells are found in a complete blood count, or to evaluate whether other diseases are present in the bone marrow.

The test may detect the cause of the abnormality, certain types of anemia (not enough red blood cells), or cancer in the marrow. It may be used to monitor the response to treatment for some cancers.

Normal Values

The marrow has normal cells that are the correct types and numbers.

What abnormal results mean

The results may indicate cancers of the bone marrow (leukemia or Hodgkin's disease). The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).

Additional conditions under which the test may be performed:

• Disseminated coccidioidomycosis
• Hairy cell leukemia
• Hodgkin's lymphoma
• Idiopathic aplastic anemia
• Multiple myeloma
• Neuroblastoma
• Non-Hodgkin's lymphoma
• Polycythemia vera
• Primary amyloid
• Primary myelofibrosis
• Primary thrombocythemia
• Secondary aplastic anemia
• Secondary systemic amyloid

What the risks are

Persistent bleeding and infection are rare and can be controlled.

Special considerations

This test is often performed when there are problems with the various types of blood cells. The person may be at increased risk for bleeding, infection, or other problems.

References

McPherson RA and Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: WB Saunders; 2007:478-81.

Hoffman R, Benz Jr. EJ, Shattil SJ, et al., eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Churchill Livingston; 2005:2657.