What is a bone marrow biopsy?

A bone marrow biopsy involves removing a small sample of the bone marrow inside your bones for testing. Bone marrow is a soft tissue in the center of most large bones. It makes most of the body's blood cells.

The biopsy is done using a small needle inserted into the bone. The bone marrow tissue is removed and then sent to a lab and checked under a microscope. You may be given a shot (injection) of a local anesthetic before the biopsy. This will numb the area so you don’t feel any pain.

Why might I need a bone marrow biopsy?

A bone marrow biopsy is usually done if your healthcare provider thinks that you have a problem making blood cells. A specialist called a pathologist looks at blood and bone marrow samples in a lab. The pathologist can check your bone marrow for:

• Unexplained lack of red blood cells (anemia)

• Abnormal numbers of blood cells (red blood cells, white blood cells, or platelets)

• Lack of iron (iron deficiency)

• Cancers of the blood-forming tissue (leukemia or lymphoma)

• Cancers that have spread to the bone marrow

• Response to chemotherapy

There may be other reasons for your healthcare provider to advise a bone marrow biopsy.

What are the risks of a bone marrow biopsy?

As with any procedure, problems can occur. Some possible risks may include:

• Bruising and discomfort at the biopsy site

• Prolonged bleeding from the biopsy site

• Infection near the biopsy site

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a bone marrow biopsy?

• Your healthcare provider will explain the procedure to you. Ask him or her any questions you have.

• You may be asked to sign a consent form that gives permission for the procedure. Read the form carefully and ask questions if anything is not clear.

• Tell your provider if you are pregnant or think you may be pregnant.

• Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia medicines (local and general).

• Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.

• Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

• Follow any directions you are given for not eating or drinking before the biopsy.

• You may get a medicine (sedative) to help you relax before the biopsy. The sedative may make you drowsy. So you will need to have someone drive you home.

Your healthcare provider may have other instructions for you based on your health condition.

What happens during a bone marrow biopsy?

You usually have a bone marrow biopsy as an outpatient. This means you go home the same day. Procedures may vary depending on your condition and your provider’s practices.

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

Generally, a bone marrow biopsy follows this process:

1. You may be asked to remove clothing and may 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 cleaned with a sterile (antiseptic) solution.

5. You will feel a needle stick and a brief sting as the provider injects a local anesthetic to numb the area.

6. The provider may make a small cut (incision) over the biopsy site. The biopsy needle will be put through the bone and into the bone marrow.

7. A bone marrow aspiration is usually done first. The provider 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 your bone. You will have a pulling feeling when the marrow is removed.

8. The provider 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 removed. Firm pressure will be put on 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 to keep the biopsy area clean and dry. Your healthcare provider will give you specific bathing instructions. Leave the bandage in place for as long as directed by your provider. This is often until the next day.

Take a pain reliever as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Be sure to take only medicines your healthcare provider has approved.

Call your provider if you have any of the following:

• Fever

• Redness, swelling, bleeding, or other drainage from the biopsy site

• More pain around the biopsy site

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

Your healthcare provider may give you other instructions, 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

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would  happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure