Bone Marrow Biopsy

Bone marrow is the spongy material found in the center of most large bones in the body. The different cells that make up blood are made in the bone marrow. Bone marrow produces red blood cells, white blood cells, and platelets. Along with a biopsy (the sampling of mostly solid tissue or bone), an aspiration (the sampling of mostly liquid) is often done at the same time.

• Why the procedure is performed: A bone marrow aspiration and biopsy procedure is done for many reasons.
  
  
  • The test allows the doctor to evaluate your bone marrow function. It may aid in the diagnosis of low numbers of red blood cells (anemia), low numbers of white blood cells (leukopenia), or low numbers of platelets (thrombocytopenia), or a high number of these types of blood cells.
    
    
  • The doctor can also determine the cause of some infections, diagnose tumors, determine how far a disease, such as lymphoma, has progressed, and evaluate the effectiveness of chemotherapy or other bone marrow active drugs.
  
  
• Where the procedure is performed: Bone marrow aspirations and biopsies can be performed in doctor's offices, outpatient clinics, and hospitals. The procedure itself takes 10-20 minutes.

You will be asked to sign a consent form before the procedure. You will be notified of the alternatives as well as the potential risks and complications of this procedure.

Possible risks include these:

• Persistent bleeding and infection

• Pain after the procedure

• A reaction to the local anesthetic or sedative

• You may receive instructions about not eating food or drinking liquids before the procedure.

• Be sure to tell your doctor about any prescription medications, over-the-counter medications, as well as herbal supplements you are taking.

• Notify your doctor about all allergies, previous reactions to medications, if you have had any bleeding problems in the past, or if you are pregnant.

• Before the procedure, you will be asked to change into a patient gown.

• Your vital signs—blood pressure, heart rate, respiratory rate, and temperature—will be measured.

• Depending on your doctor, you may have an IV placed or your blood drawn.

• You may be given some medicine to help you relax.

• You may be asked to position yourself on your stomach or your side depending on the site the doctor chooses to use.

• The doctor will choose a place to withdraw bone marrow. Often this is the hip (pelvic bone), but it also can be done from the breastbone (sternum), lower leg bone (tibia), or backbone (vertebra).
  
  
• The chosen site will be cleaned with a special soap (iodine solution) or alcohol. After the skin is clean, sterile towels will be placed around the area. It is important that you do not touch this area once it has become sterile.
  
  
• Local anesthetic, usually lidocaine, will be injected with a tiny needle at the site. Initially, there may be a little sting followed by a burning sensation. After a few minutes, the site will become numb. A needle is then placed through the skin and into the bone. You may feel a pressure sensation.
  
  
  • For the bone marrow aspiration, a small amount of bone marrow is then pulled into a syringe.
    
    
  • A bone marrow biopsy is then usually performed. A somewhat larger needle is then put in the same place and a small sample of bone and marrow is taken up into the needle.
  
  
• The wound site may bleed a small amount, so pressure is applied for a few minutes. A sterile bandage is then applied.

If you receive sedative medication, you will continue to feel drowsy for a while. After the local anesthetic wears off over the next few hours, you may have some discomfort at the biopsy site. Your doctor will advise you about pain medication.

You should keep the bandage on for 48 hours, and then it should be removed.

The samples taken from your bone marrow will be sent to a laboratory and the pathologist for analysis. Several tests are done including looking at the bone marrow under a microscope. The results of these tests will usually be available in a few days. Your doctor will give you instructions for follow-up.

Call your doctor if you notice signs of spreading redness, continued bleeding, fever, worsening pain, or if you have other concerns after this procedure.

Go to a hospital's emergency department if these conditions develop:

• If your bleeding will not stop with direct pressure

• If you see thick discharge from the wound

• If you have a persistent fever

• If you feel lightheaded

bone marrow aspiration, anemia, leukopenia, thrombocytopenia, red blood cells, lymphoma, bone marrow biopsy

Author: Troy M Falck, MD, Clinical Associate Professor of Emergency Medicine, University of California at Davis; Consulting Staff, Department of Emergency Medicine, Kaiser Permanente Medical Center-Sacramento.

Coauthor(s): Darilyn Campbell Falck, MD, Staff Physician, Department of Emergency Medicine, Sutter Roseville Medical Center.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Jeter (Jay) Pritchard Taylor III, MD, Vice-Chief, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina.