Bone marrow is the soft, spongy tissue that is found inside the center of bones. It produces red blood cells (cells that carry oxygen to all parts of the body), white blood cells (cells that help the body fight infections and diseases), and platelets (cells that help blood clot and help control bleeding). A bone marrow biopsy and aspiration is a diagnostic examination of the bone marrow that can provide information about the development and function of these cells.

A bone marrow biopsy and aspiration may be performed to diagnose:

• an infection with an unknown cause
  
  
• blood disorders
  
  
• chromosomal or genetic diseases
  
  
• cancer of the blood cells, such as leukemia
  
  
• lymphoma
  
  
• multiple myeloma

A bone marrow biopsy and aspiration is performed in people with certain types of cancer to:

• assign the stage the cancer (a way of describing a cancer, such as where it is located, if and where it has spread, and if it is affecting the functions of other organs in the body)
  
  
• monitor the side effects of chemotherapy
  
  
• see whether the treatment is working

About the procedure

A bone marrow biopsy and aspiration are usually done at the same time. Your doctor will determine whether you need a bone marrow biopsy, a bone marrow aspiration, or both. The bone marrow has both a solid and a liquid part. A bone marrow biopsy is a procedure that removes a small, solid piece of tissue for examination. A bone marrow aspiration removes a sample of the fluid, called an aspirate. A common site for a bone marrow biopsy and aspiration is the pelvic bone, which is located in the lower back by the hip.

The medical team

A bone marrow biopsy and aspiration is usually performed by an oncologist (a doctor who treats people with cancer), a hematologist (a doctor who treats people with blood diseases), or a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Other members of the health-care team, including a nurse or physician assistant, may be present during the examination. A pathologist will examine the bone marrow cells under a microscope and the results will be summarized in a pathology report that will be given to your oncologist. Learn more about this report in the Cancer.Net Feature: Understanding a Pathology Report.

Questions to ask your doctor

Before you have a bone marrow biopsy and aspiration, consider asking your doctor the following questions:

• Who will perform the bone marrow biopsy and aspiration?
  
  
• What can I expect to happen during the procedure?
  
  
• How long will the bone marrow biopsy and aspiration take?
  
  
• What are the risks of having a bone marrow biopsy and aspiration?
  
  
• Will I be awake or asleep during the procedure?
  
  
• Will I feel any pain during the procedure? For how long? What can be done to reduce the pain?
  
  
• How soon can I return to normal activities after the procedure?
  
  
• Can you give me instructions on how to care for the wound?
  
  
• How will I receive the results?
  
  
• Will I need to repeat the procedure?

Preparing for the procedure

When you schedule your examination, you will get a detailed explanation of what you need to do to prepare for your bone marrow biopsy and aspiration. There are usually no restrictions on eating or drinking before the test, unless you are receiving general anesthesia. Your doctor will inform you of these restrictions when the test is scheduled.

During the procedure

A bone marrow examination takes about 30 minutes and is usually performed in an outpatient treatment area. You will be asked to sign an informed consent before the procedure and will be able to ask questions before it begins. Because you will be receiving a local anesthetic (numbing medication), you will need to let your doctor know if you have ever had an allergic reaction to an anesthetic. A doctor may use conscious sedation (a type of anesthesia that uses pain relievers and sedatives to induce an altered state of consciousness). People who receive conscious sedation are usually able to speak and respond during the procedure, but may not have any memory of the procedure afterwards.

If the pelvic bone is the site of the procedure, you will be asked to lie on your stomach on an examination table and the skin surrounding the site will be cleansed with an antiseptic solution. A local anesthetic is injected by a fine needle into the skin and down into the tissue next to the bone. At first, you will feel a slight stinging sensation until the area is numb. If both a bone marrow biopsy and aspiration is needed, the bone marrow aspiration is completed first. A special, hollow needle is inserted into the numbed area and pushed gently into the bone. Once the needle is fully inserted, the center portion of the hollow needle is removed and a syringe is attached to the needle. During the aspiration, the liquid portion of the bone marrow is withdrawn into the syringe. You may feel a deep, dull, aching pain for a few seconds, similar to a toothache. It may help to hold a pillow tightly or squeeze another person’s hand during these few seconds. After the bone marrow aspirate is collected, the needle is removed and the pain goes away.

For the bone marrow biopsy, a larger needle is inserted into the same area and guided through the bone. The needle is rotated until an adequate sample of tissue is removed. You may feel pain and pressure as the needle is advanced into the bone. The entire needle is then removed and a pressure dressing (a protective covering that places pressure on top of a wound) is placed over the site to prevent bleeding. The medical team may ask you to lie down for about 20 minutes to relax or “sleep off” any remaining sedation.

After the procedure

You will be able to go home shortly after the procedure and can resume normal activities the same day. If you have received sedation of any type, it is important that someone drives you home after the procedure. Keep the area around the pressure dressing clean and dry. Ask your doctor when you can remove the dressing and do not shower or bathe until that time. There will likely be some blood on the bandage, which is normal. Contact your doctor if the bleeding does not stop. You can then cover the remaining wound with a band-aid until it is fully healed. You may feel discomfort at the bone marrow biopsy and aspiration site, especially when bending over, for several days. Mild bruising is normal and can occur several days after the procedure.

Also notify your doctor if you have any of the following problems after the bone marrow biopsy and aspiration:

• fever greater than 101 degrees Fahrenheit
  
  
• unusual discharge or severe pain at the examination site
  
  
• any other signs or symptoms of infection

More Information

Tests and Procedures

Cancer.Net Feature: Donating Bone Marrow

Guest Author Series: Part I: Understanding Bone Marrow and Stem Cell Transplantation

Additional Resources

MedlinePlus Medical Encyclopedia: Bone Marrow Biopsy

Bone Marrow Aspiration