Bone Marrow Biopsy

What is a bone marrow biopsy?

A bone marrow biopsy is the removal of a small amount of bone marrow tissue from the inside of a bone. A bone marrow biopsy is performed with a needle and syringe. A biopsy is used to test the ability of the bone marrow to make healthy blood cells. Bone marrow is a spongy tissue located deep inside most bones. It makes red blood cells that carry oxygen, white blood cells that fight infection, and platelets that are important to normal clotting. A bone marrow biopsy can be used to help diagnose certain infections, diseases and disorders of the blood and bone marrow, such as leukemia and some types of anemia.

A bone marrow biopsy is only one method used to diagnose a variety of diseases and conditions of the blood and bone marrow. You should discuss different testing options with your doctor or healthcare provider to best 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.

How is bone marrow biopsy performed? 

Your bone marrow biopsy will usually be performed in a doctor’s office or outpatient setting by a team led by a doctor, often a hematologist. A hematologist is a specialist in disorders of the blood and bone marrow. An oncologist, a cancer specialist, may also perform the biopsy. A specially trained nurse or technologist may also complete the test.

Bone marrow biopsies are performed using nerve block anesthesia. A nerve block is also known as regional or local anesthesia. In local anesthesia, your doctor will inject the anesthetic in the skin and tissues around the procedure area. The bone marrow sample is usually withdrawn from the hip bone (pelvis). In some cases, the breastbone (sternum), shin bone (tibia), or backbone (vertebra) may be used. The procedure usually takes about 30 minutesand 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. In some cases, your doctor will give you a sedative medication to make you drowsy and relaxed, and possibly a pain medication. If sedation is used, your team will monitor your vital signs.
4. Your doctor will clean and numb the biopsy site with an anesthetic.
5. Your doctor will insert a biopsy needle into the bone to withdraw a sample of bone marrow.
6. Your doctor will send the bone marrow sample to the laboratory for evaluation.
7. Your doctor will remove the needle and clean and bandage the area.