Health Information

Bone Marrow Biopsy

What is a bone marrow biopsy?

In the center of most large bones there is a soft tissue called bone marrow. Bone marrow makes most of the body's blood cells.

You have both red and yellow bone marrow. Red bone marrow is the active part that makes red blood cells. Yellow bone marrow contains fat cells. In adults, red bone marrow is found in the flat bones, such as the upper hipbones, and the breastbone. In children, the red bone marrow is in the long bones, such as the femur.

A bone marrow biopsy involves removing tissue from the red bone marrow. The tissue is sent to the lab for microscopic exam. The biopsy is done using a small needle inserted into the bone. A local anesthetic agent may be given before the procedure.

Why might I need a bone marrow biopsy?

A bone marrow biopsy is usually done if your health care provider thinks that you have a problem with blood cell production. A pathologist in the lab examines blood and bone marrow samples. By using a microscope with special lab techniques, the pathologist can check the bone marrow for any of the following:

  • Unexplained anemia (a decrease in the number of red blood cells)
  • Abnormal numbers of blood cells (red blood cells, white blood cells, or platelets)
  • Bleeding or clotting disorders (such as hemophilia)
  • Iron deficiency
  • Inherited blood disorders (such as thalassemia or sickle cell disease)
  • Leukemia (a cancer of the blood-forming tissue)
  • Cancers that have spread to the bone marrow
  • Response to chemotherapy

There may be other reasons for your health care provider to recommend a bone marrow biopsy.

What are the risks of a bone marrow biopsy?

As with any surgical procedure, complications can occur. Some possible complications may include:

  • Bruising and discomfort at the biopsy site
  • Prolonged bleeding from the biopsy site
  • Infection near the biopsy site

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the procedure.

How do I get ready for a bone marrow biopsy?

  • Your health care provider will explain the procedure to you and can ask questions.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • Tell your health care provider if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • Tell your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. You may need to stop these medications prior to the procedure.
  • If you are pregnant or think you might be, tell your health care provider.
  • You may be asked to fast for several hours prior to the procedure.
  • You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
  • Based on your medical condition, your health care provider may request other specific preparation.

What happens during a bone marrow biopsy?

A bone marrow biopsy may be done on an outpatient basis. Or you may stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

A bone marrow biopsy is commonly done using a pelvic bone, but another bone (such as the breastbone) may be used. In a child, a leg bone or vertebra (bone in the spine) may be used.

Generally, a bone marrow biopsy follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. Your position may vary depending on the bone that is used. You may be asked to lie on your side or your stomach if the pelvis bone is used.
  3. During the procedure, you will need to lie as still as possible.
  4. The skin over the biopsy site will be cleansed with an antiseptic solution.
  5. You will feel a needle stick and a brief stinging sensation as the doctor injects a local anesthetic to numb the area
  6. A small incision may be made over the biopsy site. The biopsy needle will be inserted through the surface of the bone and into the bone marrow.
  7. A bone marrow aspiration is usually done first. The doctor will use a syringe to pull a small liquid sample of the bone marrow cells through the needle. It is common to feel pressure as the needle is pressed into the bone, and a pulling sensation when the marrow is removed.
  8. The doctor will remove a small, solid piece of bone marrow using a special hollow needle. This is called a core biopsy.
  9. The biopsy needle will be withdrawn. Firm pressure will be applied to the biopsy site for a few minutes, until the bleeding has stopped.
  10. A sterile bandage or dressing will be applied.
  11. The bone marrow samples will be sent to the lab for exam.

What happens after a bone marrow biopsy?

Once you are home, it is important for you to keep the biopsy area clean and dry. Your doctor will give you specific bathing instructions. Leave the bandage in place for as long as instructed by your doctor. This is usually the next day.

The biopsy site may be tender or sore for several days after the bone marrow biopsy. Take a pain reliever for soreness as recommended by your health care provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Tell your health care provider to report any of the following:

  • Fever
  • Redness, swelling, bleeding, or other drainage from the biopsy site
  • Increased pain around the biopsy site

You may go back to your usual diet and activities unless your health care provider advises you differently.

Your health care provider may give you other instructions after the procedure, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:
  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure