Cancer Care


Bone Marrow Aspiration & Biopsy

What You Need to Know

A bone marrow aspiration and a bone marrow biopsy are both diagnostic tests for people suffering from cancer, bone marrow or blood cell diseases, anemia, certain infections, or fevers of unknown origin. Although they are two different procedures, they are often done at the same time as a “bone marrow examination.”

For those suffering from a blood disorder, it can be helpful to understand these two procedures and what they entail. In both cases, the tests are important for narrowing down the cause of the illness and helping a patient recover.

Frequently Asked Questions

Bone marrow is the soft, spongy tissue in the center of your larger bones—the spine, hip, shoulders, ribs, breastbone, and skull. Bone marrow in the spine and hip is usually the source of the richest bone marrow cells, so they are usually the locations in which bone marrow examinations are done.

The bone marrow contains something called stem cells; which are cells that can develop into “specialized” cells such as red blood cellswhite blood cellsplatelets, and other cells with specific functions. Due to this, they can be referred to as primitive or unspecialized cells.

A typical bone marrow examination commonly involves both a bone marrow aspiration and biopsy and is done to get a sample of the marrow so it can be examined in a laboratory. Bone marrow has both a fluid portion and a more solid portion.

A bone marrow aspiration involves taking a sample of the liquid part of your bone marrow via suction with a special needle (usually a Jamshidi needle). A bone marrow biopsy can use the same needle or a different needle (called a trephine) that removes a tiny core of the bone marrow tissue.

A complete bone marrow examination involving both of the above tests offers a much more comprehensive view of the bone marrow than just one alone.

The procedure site for a bone marrow examination is usually the pelvic bone, in which case the sample will be taken from the back of the hip bone.

Other procedure sites can include the front of the pelvic bone (near the groin) and the sternum (front of the chest). However, the sternum can only be used for aspirations for people above 12 years of age since the sternum is thin and there is a risk of injuring the underlying tissue. In the case of children between 12 and 18 months, the bone marrow aspiration can also be collected from the tibia (shinbone).

Most bone marrow aspirations are done to diagnose conditions that affect your blood cells. They are frequently performed for cancer patients to either diagnose cancer or determine the extent of cancer within the bone marrow.

The liquid sample from a bone marrow aspiration reveals the population of cells within the bone marrow. Bone marrow aspirations are also used to detect rare non-hematologic conditions and cancers, as well as conditions like inflammation and infection that occur in people with sarcoidosis and tuberculosis. In addition, they are also used to obtain cells for transplantation purposes.

Unlike bone marrow aspirations, bone marrow biopsies remove a core part of the bone, so physicians can study the cell structure of the tissue. Since the bone marrow aspiration only shows the mixed cells in the marrow, and not their relationship to each other, the bone, and their precise locations. Bone marrow biopsies usually follow an aspiration.

Your doctor may order a bone marrow examination if you have signs of unhealthy bone marrow, such as abnormal levels of white or red blood cells, or platelets. In essence, bone marrow examinations can be used to:

  • Determine the cause of a disease or condition.
  • Establish which stage your disease is in.
  • Monitor the effects of treatment.
  • Study your iron levels.
  • Obtain bone marrow cells for transplantation.

Bone marrow procedures are particularly useful if you are undergoing treatment for cancer, as they can help determine how far the cancer has spread.

Bone marrow examinations are used to diagnose a variety of conditions, both cancerous and noncancerous. Cancers like leukemia and multiple myeloma come from the cells in the bone marrow, so it has to be tested to confirm the diagnosis. Cancers like lymphoma, on the other hand, can spread to the bones, which is confirmed by a biopsy.

Apart from these, the causes of low platelet counts and undiagnosed infections can be diagnosed by the culture material from the bone marrow. Although there are several more conditions, these are the most frequent ones.

How to Prepare for Your Procedure

Bone marrow procedures do not usually need much preparation. At New Jersey Cancer Care, our trained physicians perform the procedures in our facility on an outpatient basis to avoid unnecessary hospitalizations.

Although there’s nothing specific you need to do, it’s important to share some information in advance with your doctor. Let your doctor know if you are allergic to chlorhexidine, local anesthetics, latex, or adhesives. If you take any medicines, including supplements, inform your doctor as certain medications (such as anticoagulants) can increase the risk of bleeding post-procedure.

What Happens During a Bone Marrow Examination

A bone marrow examination is usually done by a hematologist, medical oncologist, internist, pathologist, or transplant specialist. Prior to the examination, your blood pressure, heart rate, and body temperature will be checked by the medical staff. The area where the needle will go will be disinfected and numbed to minimize pain and discomfort. Typically, patients are given a local anesthetic to numb the examination site; however, if the patient has asked for a sedative, it will be given a few minutes in advance.

A physician will then make a small incision and use a hollow needle to penetrate the outer layer of the bone. You will likely feel some pressure at this point. If they are using a Jamshidi needle, they will use it for both bone marrow liquid aspiration and bone marrow core removal. Alternatively, the first needle will be removed, and a slightly larger needle will be used for the bone marrow biopsy.

Once the needle is inside the bone, a syringe will be attached to collect the bone marrow liquid. This part of the procedure is usually the most painful due to the negative pressure in the area, but it only lasts a few seconds.

After this, a biopsy can be done by rotating the needle to cut a small piece of the core that is then contained within the needle. Once the needle is removed, the core can be extracted.

Since the cut made in the skin is very small (less than ¼ inch), stitches are unnecessary and a bandage will suffice. The entire examination will take around 30 minutes to complete, with each procedure taking around 10 minutes.

What to Expect After the Procedure

Once the examination is complete, you might feel lightheaded and have some numbness and soreness in the part of your body where the needle was inserted. You may also get a bruise on the site of the examination. If you requested to be sedated for the examination, you would need to arrange for someone to take you home.

Bone Marrow Aspiration and Biopsy Recovery

Since bone marrow examinations are usually outpatient procedures, there isn’t much that needs to be done in terms of recovery. However, there are a few things you need to do:

  • Keep your bandage dry for 24 hours. Do not shower, bathe, swim, or do anything that can get the bandage wet.
  • Ask your doctor before taking any aspirin or medications containing aspirin.
  • Ask your doctor before restarting any medications you were on prior to the procedure, such as blood thinners.
  • Avoid any rigorous exercise or activity for a couple of days.
  • Contact your doctor if you experience any of the following: bleeding that does not stop after applying pressure, worsening pain, persistent fever, swelling, or any unusual discharge.

Risks and Complications of a Bone Marrow Examination

Bone marrow examinations are relatively quick and simple procedures, so the risk factor is quite low. Complications from a bone marrow examination are extremely rare, with less than one percent of bone marrow examinations resulting in complications.

The main risk of the procedure is hemorrhage, but other risks can include infection, prolonged pain, or an allergic reaction to the anesthesia. Since bone marrow examinations are always performed by trained physicians and are almost exclusively done on the pelvic bones, it is one of the safest medical procedures.

New Jersey Cancer Care is dedicated to walking beside you in your fight against cancer. We provide bone marrow aspiration and biopsy procedures in our state-of-the-art office. Our facility provides a convenient and personalized experience for every single one of our patients to keep you as comfortable as possible. Contact us today to learn more.