What is a bone marrow biopsy?

A bone marrow biopsy is the removal of a small amount of bone marrow from inside a bone. Bone marrow is a spongy tissue deep inside most bones. It makes red blood cells that carry oxygen and white blood cells that fight infection. A bone marrow biopsy determines if your bone marrow makes healthy blood cells. It helps diagnose blood and bone marrow conditions, including leukemia and infection.

A bone marrow biopsy is only one method used to diagnose a diseases and conditions of the blood and bone marrow. Discuss different testing options with your doctor to understand which option is right for you.

Why is bone marrow biopsy performed? 

Your doctor may recommend a bone marrow biopsy to diagnose a variety of diseases and conditions including:

  • Anemia, an abnormally low number of red blood cells in the blood. A bone marrow biopsy may be used if the underlying cause has not been diagnosed by less invasive testing. Aplastic anemia is a rare type of anemia that occurs when the bone marrow does not produce enough red blood cells.
  • Cancer, such as lymphomas, leukemias, and multiple myeloma. These are cancers of the blood and bone marrow. A bone marrow biopsy may also be performed for other types of cancer, such as breast, lung, or bone cancer, to determine if the cancer has spread to the bone marrow.
  • Essential thrombocythemia, a condition in which the bone marrow produces too many platelets leading to bleeding and clotting problems 
  • Fever, if the underlying cause not been diagnosed with less invasive testing. This is especially relevant for patients who have compromised immune systems, such as from HIV/AIDS.
  • Infection of the bone marrow. Bloodstream and other types of infections can spread to the bone marrow.
  • Iron storage disorders in which too much iron is stored by the body and builds up in the bone marrow
  • Myelodysplastic syndromes in which the bone marrow does not produce enough healthy blood cells 
  • Myelofibrosis, a disorder in which healthy bone marrow is replaced by scar tissue
  • Neutropenia, which is an abnormally low number of white blood cells called neutrophils. Neutropenia reduces the body’s ability to fight infection.

Who performs bone marrow biopsy?

The following specialists perform bone marrow biopsy:

  • Hematologists are doctors who specialize in diseases and disorders of the blood and bone marrow.
  • Oncologists are doctors who specialize in cancer.
  • Pediatric hematologists/oncologists are doctors who specialize in diagnosing and treating children with cancer or diseases and disorders of the blood and bone marrow.

How is bone marrow biopsy performed?

Your bone marrow biopsy will be performed in a doctor’s office, outpatient setting, or sometimes a hospital. The procedure usually takes about 30 minutes and generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.
  2. A member of the biopsy team will position you on the table to allow access to the bone marrow biopsy site. 
  3. You may have a sedative medication to make you drowsy and relaxed, and possibly a pain medication. Your team will monitor your vital signs if you have sedation.
  4. Your doctor will clean and inject a local anesthetic in the skin and tissues around the procedure area. This will numb the area so you do not feel any pain.
  5. Your doctor will insert a biopsy needle into the bone to withdraw a sample of bone marrow. Bone marrow is usually withdrawn from the hipbone (pelvis). The breastbone (sternum), shinbone (tibia), or backbone (vertebra) may be used. Your doctor will remove the needle and clean and bandage the area.
  6. Your doctor will send the bone marrow sample to the laboratory for evaluation.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You may feel a pinch, discomfort or stinging when the test area is numbed and pressure during the procedure. There may be some brief, sharp pain when the bone marrow is withdrawn, although not everyone feels this pain. The bone itself cannot be numbed.&