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Bone Marrow Biopsy and Aspiration

What to Expect During a Bone Marrow Biopsy


Updated December 02, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Bone marrow is the spongy tissue that is found in the hollow center of the large bones in our body. It is responsible for the production of red blood cells, white blood cells, and platelets. In diseases and conditions related to the blood, examining the marrow can be a vital diagnostic tool. This can be accomplished through the aspiration and/or biopsy of bone marrow.

Bone marrow aspiration and biopsy give doctors comprehensive insight into the condition of the marrow, helping to diagnose and monitor blood and marrow diseases -- especially blood cancers, such as leukemia, lymphoma, and multiple myeloma.

Bone marrow examination through aspiration and biopsy are also used in the cancer staging process to determine if cancer has spread to the bone marrow. Not all bone marrow tests are cancer related, however. The test is also useful in diagnosing benign conditions.

How to Prepare

For most people, no special preparation is needed before having the test. In most cases, a local anesthetic is used, so there is no required dietary restriction before the test. In a small amount of people, IV sedation may be recommended to relieve extreme anxiety and for relaxation. If you undergo IV sedation, you may be asked to avoid drinking and eating the night before the procedure. An oral sedative may also be available.

You will be asked to sign a consent form, which gives the doctor permission to perform the aspiration and/or biopsy and to ensure you are aware of the possible risks and complications. Minor bleeding can occur at the puncture site and is to be expected. More serious risks, such as infection and excessive bleeding, can occur, although rare. If you have any questions, don't hesitate to ask your doctor.

Before the biopsy, ensure your doctor is aware of all medications you take, including prescription medications, over-the-counter drugs, vitamins, and herbs. Let your doctor know if you have any allergies to lidocaine, which is commonly used to numb the biopsy site. The soap used to clean the skin may contain iodine, so be sure to let your doctor know if you have an allergy to iodine, as well.

Your doctor will also want to know if you have any bleeding disorders or are currently taking blood thinners, such as Heparin, warfarin, or other anticoagulant medications, like aspirin.

How a Bone Marrow Biopsy is Performed

The test usually takes about 30 minutes and is performed by a hematologist or oncologist. If you have sedation, you will have to arrive earlier for the test and leave later than someone who is not sedated. In most cases, a bone marrow biopsy is performed as an in-office procedure.

The back of the hip bone (posterior iliac crest) is the most common site for a bone marrow biopsy and aspiration. Other sites may be available, such as the front of the hip bone (anterior iliac crest), if the back of the hip bone cannot be accessed because of obesity or other factors.

You will be asked to lie on your side with your legs slightly bent or on your stomach. The lower back/hip area is then cleaned with a special antiseptic. Your doctor will then begin to palpate along your hip bone to determine the biopsy site. Once the site is determined, a sterile drape with a small window cut out will be placed over the site. Your doctor will then numb the area using lidocaine or other anesthetic. You may feel a slight burning sensation.

If your doctor is doing both aspiration and a biopsy, the aspiration will be performed first. A special needle will puncture the skin to the bone marrow. A syringe is then attached to the needle and fluid is aspirated. Most patients find aspiration to be the most painful part of the procedure, but the discomfort only lasts for a few seconds.

To obtain a solid sample of bone marrow (a biopsy), the doctor then inserts a hollow needle into the skin to the bone marrow. You may feel pressure, but if you feel any sharp pain, let your doctor know. Once the sample is collected, the needle is removed and the procedure is over.

After a Bone Marrow Biopsy

After the biopsy is complete, a bandage will be placed over the site and you will be asked to lie on your back for about 30 minutes following the procedure. This is to ensure that you do not experience abnormal bleeding after the biopsy. You can expect mild lower back pain. Barring any unusual circumstances, you will be able to go home the same day. You will likely be able to remove the bandage the following day.

If you experience increased pain or bleeding at the biopsy site after you go home, call your doctor.

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