Bone Marrow Biopsy and Aspiration
Overview
Doctors use bone marrow aspiration and biopsy to collect samples from the inside of large bones. These tests check both the liquid and solid parts of bone marrow. The liquid part is drawn out with a needle during aspiration, while the solid part is taken out during a biopsy.
Often, doctors do both procedures together and refer to this as a bone marrow exam. These tests help find issues with blood cell production and spot diseases that affect the blood or marrow. Conditions such as certain cancers and unexplained fevers may lead a doctor to order these tests.
Key Points:
| Procedure | Sample Taken |
|---|---|
| Aspiration | Fluid |
| Biopsy | Solid section |
| Bone Marrow Exam | Fluid & Solid |
- Bone Marrow Aspiration: Removes fluid portion.
- Bone Marrow Biopsy: Removes solid portion.
- Tests are used for diagnosis and monitoring.
Reasons for the Procedure
A bone marrow test helps doctors understand the health of blood cells, including white blood cells, red blood cells, and platelets. It also helps diagnose problems like anemia, where someone has too few red blood cells, or other blood disorders that can cause too many or too few cells.
The findings can show if the body’s iron levels are normal and if blood cells are being made properly. Doctors often use this procedure to check for blood cancers such as leukemia and lymphoma, and to find out if these cancers have spread. They may also use bone marrow exams to check if treatment is working for cancers or other medical conditions.
Doctors may order this test when blood tests do not explain a patient’s symptoms. Situations like unexplained infections or fevers sometimes need a closer look at the bone marrow. Doctors may order bone marrow exams for these reasons:
- To learn about fevers that don’t have an obvious cause.
- To check for blood cancers: leukemia, lymphoma, and multiple myeloma.
- To diagnose blood disorders: anemia, thrombocytopenia, or pancytopenia.
- To watch the progress or treatment of illnesses.
- To find out if cancer from another area, like the breast, has reached the marrow.
Possible Side Effects and Problems
Bone marrow exams may lead to some risks, although they are uncommon. Common issues can include:
- Discomfort and minor pain at the procedure site.
- Bleeding, especially for people with low platelet counts.
- Bruising where the needle went in.
- Infection near where the skin was pierced.
- Allergic reaction to numbing medicine, though this is rare.
Less often, complications can involve heart or lung problems if the needle enters the breastbone.
How You Get Ready
Before a bone marrow test, follow a few steps to prepare. Most people do not need to do anything special, especially if the procedure is an outpatient visit. If you will receive a sedative, you may need to stop eating and drinking for a set time before the test.
Discuss all medications and supplements with your healthcare provider, as some can affect bleeding risk. Share any concerns you have. The doctor may offer a sedative to help with anxiety, along with a local anesthetic to numb the area. Arrange for someone to drive you home after sedation. Complete the consent form and follow these steps to help make the process smoother.
What You Can Expect
Preparing for the procedure
When you get ready for a bone marrow aspiration and biopsy, the care team checks your blood pressure and heart rate first. They provide anesthesia to make you comfortable. Usually, local anesthesia numbs the skin and tissue around the biopsy site, often the iliac crest at the back or front of the hip.
Some people receive IV sedation if they are worried about pain or feel anxious. Staff mark the chosen site, clean it with antiseptic, and drape it to keep the area sterile. Most often, you will lie on your side or abdomen. The area stays exposed, while the rest of your body remains covered with a cloth.
Table: Where Samples Are Commonly Taken
| Location | Who Usually Has It Taken Here? |
|---|---|
| Back of hipbone (iliac crest) | Most adults and older children. |
| Front of hipbone | Sometimes used if the back cannot be accessed. |
| Breastbone (sternum) | Rarely used, mostly for aspiration only. |
| Lower leg bone (children) | Infants under 12 to 18 months. |
Collecting a Bone Marrow Fluid Sample
To start the bone marrow aspiration, a medical professional makes a small cut in the skin. They place a hollow, rigid needle through the bone and into the spongy marrow inside. The needle usually attaches to a syringe, and they pull out the liquid part of the bone marrow.
This step is fast, but may cause quick, sharp pain or a stinging feeling. Several fluid samples may be needed. If fluid cannot be obtained on the first attempt, the medical professional may reposition the needle and try again. The healthcare team checks right away to ensure the sample is good.
Common Details
- Uses a hollow needle and syringe.
- A small amount of marrow fluid is taken.
- May feel a sudden, sharp pain.
- Performed before the biopsy.
Taking a Bone Marrow Tissue Sample
After the aspiration, the medical professional uses a different, larger needle to collect a solid piece of bone marrow tissue. This is called a “core biopsy.” The needle is specially designed to remove a cylinder-shaped sample from the core of the bone, usually still at the iliac crest.
Trained staff ensure they collect enough tissue. The process takes only a few minutes. The core biopsy allows doctors to see the structure and types of cells in the bone marrow itself.
Key Features
- Uses a thicker needle.
- Takes a small, solid core of bone marrow.
- Let doctors study bone structure along with blood cells.
Steps After the Exam
Once the procedure is finished, staff place pressure on the site to reduce bleeding and apply a bandage. If you received only local anesthesia, you will be asked to lie still for about 10โ15 minutes, applying gentle pressure to the site. If you received sedation, you are moved to a recovery area and monitored until fully awake.
Arrange a ride home and rest for the day if you had IV medication. You may feel mild soreness or tenderness at the biopsy site for a week or more. Over-the-counter pain relievers such as acetaminophen are sometimes suggested. Avoid strenuous activity until you feel comfortable.
Common Aftercare Instructions
- Rest quietly following the test.
- Resume normal activity when able.
- Use mild pain relief as advised.
- Expect some bruising or discomfort.
Caring for the Biopsy Area
Proper care of the site helps prevent problems. Keep the bandage on and dry for the first 24 hours. Avoid showering, swimming, or bathing during that time. After a day, gently clean the area with water as usual.
Wait at least a day or two before doing vigorous exercise or heavy lifting. If the bandage becomes soaked with blood, or if you notice pain that gets worse, swelling, redness, fever, or any unusual drainage, contact your doctor promptly.
Important Things to Watch For:
- Ongoing Bleeding: Does not stop with pressure or soaks the bandage.
- Fever: Temperature remains high or increases after the procedure.
- Worsening Pain: Discomfort that does not get better with rest or medicine.
- Redness or Swelling: Grows larger or looks infected.
Test Findings
After collecting the bone marrow samples, the lab studies them closely. Pathologists examine the samples to find out if there are enough healthy bone marrow cells and spot any abnormal or diseased cells. Doctors also review the chromosomal analysis to look for genetic changes. This information helps them:
- Identify or dismiss certain illnesses.
- Check how far a disease has progressed.
- See if treatments are effective.
Results are usually ready in a few days, but sometimes it can take longer. Extra tests might be needed based on what is found.
