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What Is a Bone Marrow Biopsy?

Overview

  1. A bone marrow biopsy is part of a bone marrow test that takes a sample of your solid bone tissue.
  2. This test looks for abnormalities in your blood cells and signs of any diseases.
  3. You can request anesthesia or a sedative before the biopsy, and manage any pain afterward with over-the-counter medications.

A bone marrow biopsy can take about 60 minutes. Bone marrow is the spongy tissue inside your bones. It’s home to blood vessels and stem cells that help produce:

  • red and white blood cells
  • platelets
  • fat
  • cartilage
  • bone

There are two types of marrow: red and yellow. Red marrow is mainly found in your flat bones such as your hip and vertebrae. As you age, more of your marrow becomes yellow due to an increase in fat cells. Your doctor will extract red marrow, usually from the back of your hip bone. And the sample will be used to check for any blood cell abnormalities.

The pathology lab that receives your marrow will check to see if your bone marrow is making healthy blood cells. If not, the results will show the cause, which may be an infection, bone marrow disease, or cancer.

Read on to learn more about a bone marrow biopsy and what happens during and after the procedure.

Do you need a bone marrow biopsy?

Your doctor may order a bone marrow biopsy if your blood tests show your levels of platelets, or white or red blood cells are too high or too low. A biopsy will help determine the cause of these abnormalities, which can include:

  • anemia, or a low red blood cell count
  • bone marrow diseases, such as myelofibrosis or myelodysplastic syndrome
  • blood cell conditions, such as leukopenia, thrombocytopenia, or polycythemia
  • cancers of the bone marrow or blood, such as leukemia or lymphomas
  • hemochromatosis, a genetic disorder in which iron builds up in the blood
  • infection or fever of unknown origin

These conditions can affect your blood cell production and the levels of your blood cell types.

Your doctor may also order a bone marrow test to see how far a disease has progressed, to determine the stage of a cancer, or to monitor the effects of a treatment.

Risks of a bone marrow biopsy

All medical procedures carry some form of risk, but complications from a bone marrow test are extremely rare. The British Society of Haematology found that less than 1 percent of bone marrow tests resulted in adverse events. The main risk of this procedure is hemorrhage, or excessive bleeding.

Other reported complications include:

  • allergic reaction to anesthesia
  • infection
  • persistent pain where the biopsy was done

Talk to your doctor before the biopsy if you have a health condition or take medication, especially if it increases your risk for bleeding.

How to prepare for a bone marrow biopsy

Discussing your concerns is one of the first steps of getting ready for a bone marrow biopsy. You should tell your doctor about all of the following:

  • any medications or supplements you are taking
  • your medical history, especially if you have a history of bleeding disorders
  • any allergies or sensitivities to tape, anesthesia, or other substances
  • if you're pregnant or think you might be
  • if you have extra anxiety about having the procedure and need medication to help you relax

Having someone come with you on the day of the procedure is a good idea. Especially if you’re getting medication like sedatives to help you relax, although this is not usually needed. You shouldn’t drive after taking them as these medications can make you feel drowsy.

Follow all of your doctor’s instructions before the procedure. Your doctor may ask you to stop taking certain medications beforehand. But never stop taking a medication unless your doctor instructs you to do so.

Getting a good night’s rest and showing up on time, or early, to your appointment may also help you feel less tense before the biopsy.

Pain preparation

On average, the pain from the biopsy is reported to be short-lived, average, and less than anticipated. Some studies show that the pain is connected to the duration and difficulty of a biopsy. Pain is significantly reduced when an experienced doctor takes less than 10 minutes to complete the biopsy.

Another important factor is your anxiety level. People who were knowledgeable about their procedure report experiencing a lot of pain less often. People also report lower levels of pain with subsequent biopsies.

How your doctor will perform a bone marrow biopsy

You can have the biopsy performed in your doctor’s office, a clinic, or hospital. Usually a doctor who specializes in blood disorders or cancer, such as a hematologist or an oncologist, will perform the procedure. The actual biopsy itself takes about 10 minutes.

Before the biopsy, you’ll change into a hospital gown and have your heart rate and blood pressure checked. Your doctor will tell you to sit on your side or lie on your stomach. Then they’ll apply a local anesthetic to the skin and to the bone to numb the area where the biopsy will be taken. A bone marrow biopsy is most commonly taken from the ridge of your rear hipbone or from the chest bone.

You may feel a brief sting as the anesthetic is injected. Then your doctor will make a small incision so a hollow needle can easily pass through your skin.

Bone marrow tests
A bone marrow test consists of both a bone marrow biopsy and a bone marrow aspiration. Aspiration is when your doctor collects liquid bone marrow. It’s usually done before removing the solid marrow sample.

The needle goes into the bone and collects your red marrow, but it does not come near your spinal cord. You may feel a dull pain or discomfort as the needle enters your bone.

After the procedure, your doctor will hold pressure to the area to stop any bleeding and then bandage the incision. With local anesthesia, you can leave your doctor’s office after about 15 minutes.

What happens after a bone marrow biopsy?

You may feel slight pain for about a week after the procedure but most people will not. To help manage the pain, your doctor may recommend over-the-counter pain relievers like ibuprofen or acetaminophen. You will also need to care for the incision wound, which involves keeping it dry for 24 hours after the biopsy.

Avoid strenuous activities for about one or two days to avoid opening your wound. And contact your doctor immediately if you experience:

  • excess bleeding
  • increased pain
  • swelling
  • drainage
  • fever

The lab will test your bone marrow during this time. Waiting for the results can take one to three weeks. Once your results come in, your doctor may call or schedule a follow-up appointment to discuss the findings.

What do your biopsy results mean?

A primary purpose of the biopsy is to find out whether your bone marrow is functioning properly, and if not to determine why. Your sample will be examined by a pathologist who will perform several tests to help determine the cause of any abnormalities.

If you have a certain type of cancer like lymphoma, a bone marrow biopsy is done to help stage the cancer by determining whether or not the cancer is in the bone marrow.

Abnormal results may be due to cancer, infection, or another bone marrow disease. Your doctor may need to order more tests to confirm a diagnosis. And they will discuss the results and treatment options if needed and plan your next steps during the follow-up appointment.

What does it mean to have a low platelet count? »

You asked, we answered

  • I have a bone marrow test and am stressed over it. What can I do?- Ruth, Healthline reader
  • The idea of a bone marrow biopsy can cause anxiety but most patients report that is wasn’t nearly as bad as they had imagined. The pain is minimal in most cases. Especially if done by an experienced provider. The numbing medicine used is much like what you get at the dentist and is very effective in numbing the skin and the outside of the bone where the pain receptors are. It can help to listen to music or a soothing recording during the procedure to distract you and help you relax. The more relaxed you are the easier it will be for you and the clinician preforming the procedure.

    - Monica Bien, PA-C

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