Bone marrow biopsy and aspiration

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Bone marrow biopsy and aspiration

Bone marrow biopsy and aspiration — Learn what to expect before, during, after these procedures.

Whether you're already receiving treatment for cancer or another condition or doctors are trying to make a diagnosis, your bone marrow has a story to tell. Bone marrow is responsible for the creation of your blood cells, and because of that, it holds a wealth of clues about your health. A bone marrow biopsy and bone marrow aspiration examine your bone marrow to look for those clues.

Bone marrow is spongy tissue found inside some of your larger bones. Bone marrow has a fluid portion and a more solid portion. Bone marrow in your breastbone, hips, ribs, skull and spine contains stem cells. These stem cells turn into white blood cells, red blood cells and platelets; they aren't the same as embryonic stem cells.

How are a bone marrow biopsy and aspiration done?

A bone marrow exam can be done in the hospital, a clinic or a doctor's office. A bone marrow biopsy and aspiration are usually done by a doctor, such as a specialist in blood disorders (hematologist) or a cancer specialist (oncologist), by a nurse, or by a specially trained technologist.

A bone marrow sample is usually taken from the back of one of your hipbones, in an area called the posterior iliac crest. Aspiration is usually done at the same place. However, in some cases, the aspirate fluid can be taken from the breastbone or from the front of the iliac crest near the groin. In babies and very young children, the aspirate may be taken from the lower leg bone, just below the knee.

Bone marrow exam

Illustration of bone marrow exam

In a bone marrow exam, small samples of liquid bone marrow and more solid bone marrow are withdrawn using needles. The procedure is usually performed at a spot in the back of your hipbone called the posterior iliac crest.

What can you expect during a bone marrow biopsy and aspiration?

The bone marrow exam typically takes about 30 minutes. If you have IV sedation, the procedure can take longer because of additional preparation and post-procedure care.

Bone marrow aspiration
The bone marrow aspiration is usually done before the bone marrow biopsy. For the aspiration, a hollow needle is inserted through an incision and on through the bone and into the bone marrow cavity of your iliac crest. Because local anesthetics aren't able to numb the interior of your bone, you may feel a deep, aching pain when the needle is fully inserted.

A syringe is used to draw a sample of the liquid portion of the bone marrow into the hollow needle. As the liquid is drawn up, you may feel a painful stinging, sucking or pulling sensation, which may travel down your leg. The aspiration takes only a few minutes. You may need to have several samples taken.

Your health care team checks the sample to make sure it's adequate. If it is, the needle is removed. In rare cases, a "dry tap" may occur. This is when fluid can't be withdrawn. The needle may need to be repositioned for another attempt.

Bone marrow biopsy
A different type of needle is inserted for the bone marrow biopsy. Getting this needle through the bone and into the marrow can be difficult. You may feel a lot of pressure or maneuvering as the needle is positioned properly.

A core sample of bone marrow is taken with the needle. You may feel a dull, aching pain for a moment as the sample is taken. Again, the pain may travel down your leg. You also may have a sensation of tugging or pushing, but not pain. Like the aspiration, the biopsy takes only a few minutes.

Again, your health care team checks the sample, and if it's adequate, the needle is removed.

Following the examination
After your bone marrow exam, a large pressure bandage is applied to help minimize bleeding.

If you had IV sedation, you'll be taken to a waiting area to recover from the effects of the sedation. If you're returning home after the procedure, have someone else drive you. Because the anesthesia may cause impaired judgment, memory lapses or slowed response times, you may be unable to resume all of your normal activities for another 24 hours.

If you had local anesthesia, you may have to lie on your back for at least 15 minutes to apply pressure to the biopsy site. You can then leave and go about your day, returning to normal activities as soon as you feel up to it.

Whether you had IV sedation or local anesthesia, you may feel pain or mild discomfort for a week or more after your bone marrow exam. If the pain is intolerable, ask your doctor about what kind of pain relievers you can take. You can also try to control pain without medications if you're concerned about the health risks of pain relievers. For instance, applying a cold compress to the biopsy site may reduce pain. Light exercise, such as walking, may also help.

Site care
Keep the pressure bandage on and dry for the next 24 hours. Don't take a shower or a tub bath and don't swim or use a hot tub. After 24 hours, it's OK to get the biopsy area wet and to replace the pressure bandage with a regular adhesive bandage.

A small amount of bleeding is normal. However, if bleeding soaks through the bandage or doesn't stop with direct pressure, contact your health care team as soon as possible.

Other situations in which to contact your health care team include:

  • Developing a persistent fever
  • Unrelenting or worsening pain or discomfort
  • Swelling at the biopsy site
  • Increasing redness or drainage at the biopsy site

Although you can often return to normal activities after a bone marrow exam, avoid heavy activity or exercise for the next 24 hours. This will help minimize bleeding and discomfort.

Last Updated: 11/15/2007
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