Bone Marrow Biopsy

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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. 

Your doctor will give you pain and sedative medications as needed so you stay as relaxed and comfortable. Tell your doctor if your discomfort lasts more than a moment.

What are the risks and potential complications of bone marrow biopsy?  

Complications after bone marrow biopsy are uncommon, but any procedure involves risks and potential complications.  Complications may become serious in some cases. Complications can develop during the procedure or recovery. 

Risks and potential complications of bone marrow biopsy include: 

  • Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing

  • Bleeding

  • Infection

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and: 

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

  • Informing your doctor if you are nursing or there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies 

How do I prepare for my bone marrow biopsy?

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and help your doctor obtain the most accurate test results. 

You can prepare yourself for bone marrow biopsy by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Learning about the procedure and asking any questions you may have.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Having a bone marrow biopsy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a bone marrow biopsy and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Common questions include:

  • Why do I need bone marrow biopsy? Are there any other options for diagnosing my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can return to work and other activities?

  • What kind of assistance will I need at home? Will I need a ride home?

  • How should I take my medications? 

  • How will you treat my pain?

  • When and how will I get the results of my test?

  • What other tests might I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours. 

What can I expect after my bone marrow biopsy?

Knowing what to expect after bone marrow biopsy can help you get back to your everyday life as soon as possible.

How will I feel after the bone marrow biopsy?

You might feel a little drowsy if you had sedative and pain medications. You may have mild soreness, tenderness or pain in the area where the biopsy needle was inserted. Take pain medications only as directed by your doctor. You may not be able to take nonsteroidal anti-inflammatory drugs (NSAIDs) if you have a bleeding disorder or some other conditions.  

When can I go home?

You can generally go home when any bleeding from the biopsy site has stopped, in about 10-15 minutes. Bleeding is generally minimal. 

You will need to stay in the outpatient facility or hospital for a little longer if you have sedation. You will go home when you are fully alert, breathing effectively, and your vital signs are stable. This generally takes less than an hour, depending on the type of sedation you had. 

You will be drowsy for about 24 hours after sedation and cannot drive during this time. You will need a ride home from your procedure, and someone should stay with you for the first day.

When should I call my doctor?

It is important to keep your follow-up appointments after bone marrow biopsy.  Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have: 

  • Bleeding 
  • Drainage from the site 
  • Fever 
  • New or unexplained symptoms
  • Pain that is not controlled by your pain medication, new pain, or increase in pain
  • Rash or skin irritation of the biopsy site
  • Swelling, warmth or redness of the biopsy site
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 4
  1. Bone Marrow Aspiration and Biopsy. Lab Tests Online.
  2. Bone Marrow Biopsy. Harvard Health Publication.
  3. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine.
  4. General Information about Myelodysplastic Syndromes. National Cancer Institute.
  5. Primary Thrombocytopenia. University of Maryland Medical Center.
  6. What is Aplastic Anemia? National Heat Lung and Blood Institute.
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