Bone Marrow Biopsy and Aspiration

June 12, 2024 

This page was reviewed under our medical and editorial policy by Leslie Popplewell, M.D., hematologist and medical director of Hematology and Blood and Bone Marrow Transplant, City of Hope^® Cancer Center Atlanta

A bone marrow test often includes two components, which are usually performed at the same time:

• Bone marrow aspiration removes fluid from the bone’s spongy center, called the marrow
• Bone marrow biopsy collects a solid piece of marrow

Bone marrow produces red blood cells (RBCs), white blood cells (WBCs) and platelets. The samples from bone marrow tests are analyzed in a laboratory to understand how these blood components are working and what the cells in the bone marrow look like.

Doctors may order a bone marrow aspiration and biopsy to help:

• Confirm a diagnosis of cancer or a blood or bone marrow disorder
• Understand the stage or phase of cancer
• Identify the cancer’s subtype
• Determine how well treatment is working

Since certain cancer treatments such as chemotherapy and radiation therapy may affect the number of cells in bone marrow, a patient’s care team may also use these tests to look for side effects of these treatments.

Testing for Bone Marrow Disorders

Several conditions may be identified or better understood by examining bone marrow tissue and fluid. These include bone marrow disorders, infections and the blood cancers myeloma, leukemia and lymphoma.

Bone marrow procedures help pathologists (doctors who study cells and tissues) and oncologists (cancer doctors) diagnose or confirm a diagnosis of myeloma, leukemia or lymphoma. They also help determine the stage (or phase) and impact of these cancers.

Because blood cancers drive out healthy cells, patients with myeloma, leukemia or lymphoma may also experience:

• Anemia, or low red blood cell levels
• Thrombocytopenia, or low platelet levels
• Neutropenia, or low levels of neutrophils, a type of white blood cell

Bone marrow tests help in diagnosing and monitoring these conditions so they are treated properly. If treatments such as chemotherapy cause these low blood count conditions, bone marrow procedures help pinpoint that, as well.

Preparing for a Bone Marrow Test Procedure

Before a bone marrow procedure begins, it is important for a patient to have a discussion with his or her doctor about:

• Any medications or supplements the patient is taking (and which, if any, should be stopped prior to the test)
• The patient’s medical history, including any current health conditions or allergies
• Eating and drinking prior to the biopsy and aspiration, which are usually permitted
• Patient concerns, such as pain and what to expect after the test

Patients scheduled for a bone marrow procedure should keep in mind that these tests generally don’t involve general anesthesia.

Since bone marrow procedures are considered low-risk, minimally invasive tests, pain levels are generally well controlled using either:

• Local anesthesia, an injection of pain medication at the procedure site, or
• Conscious sedation, which is local anesthesia plus medication to make a patient somewhat relaxed and groggy, yet still awake and able to breathe on their own

General anesthesia involves more risks than either local anesthesia or conscious sedation. Because of the added risks associated with general anesthesia, patients who would like this option should talk with their doctor about its risks and benefits beforehand. One way to approach this is to ask to speak with the anesthesiologist, the doctor who administers pain medication, about any chronic (long-term) pain you have that may make it uncomfortable to be awake during the biopsy.

Just before the aspiration and biopsy are performed, the patient puts on a hospital gown, and their temperature, blood pressure and heart rate are checked. They’ll be asked to sign a consent form outlining the procedure’s risks and benefits and their agreement to have it performed. Finally, patients who choose conscious sedation will receive their medication.

How Is the Bone Marrow Aspiration Performed?

Typically, a nurse practitioner, physician’s assistant, oncologist or hematologist (blood disorder doctor) performs a bone marrow procedure. The bone marrow aspiration is performed first, and involves the several steps listed below.

• The patient lies on his or her side or stomach to prepare for the removal of the marrow, which is usually taken from the hip bone.
• The skin of the procedure area is cleaned with an antiseptic, and a local anesthetic is given by injection.
• Once the area is numb, a cut is made in the skin.
• A hollow needle is inserted into the opening.
• A syringe attached to the needle is used to remove the bone marrow fluid.
• The patient may experience a few seconds of pain as the needle is inserted and the fluid is removed.

How Is the Biopsy Performed?

A bone marrow biopsy is performed right after the aspiration, and involves the steps listed below.

• A bigger, hollow needle is inserted into the same cut that was used for the aspiration.
• The doctor, physician’s assistant or nurse practitioner inserts the needle into the bone and removes a sample of bone marrow tissue.
• The needle is removed, and a bandage is placed over the cut to help stop bleeding.

Patients may expect both procedures to last about 30 minutes total: a few minutes for the aspiration, about 10 minutes for the biopsy and about 15 minutes to allow the cut to stop bleeding. For people taking conscious sedation medication, the effects usually wear off in about 20 minutes.

What Happens After Testing?

It’s common to experience some soreness of the hip or area where the needles were inserted after bone marrow procedures. The doctor may prescribe pain medication to help alleviate this soreness, which typically goes away after a few days. It is important to follow aftercare recommendations, as certain over-the-counter drugs such as aspirin thin the blood and may lead to excess bleeding.

If sedation is administered, a care provider should drive the patient home. Driving, operating machinery and consuming alcohol should be avoided after sedations for about 24 hours. The bandage should stay on for about 24 hours and be kept clean and dry.

Patients should follow the aftercare instructions that the care team provides and contact their doctor if any of these more serious side effects occur:

• Intense pain at the site of the procedure
• Fever
• Bleeding that won’t stop
• Signs of an infection, such as redness, swelling and drainage

In addition to these more serious symptoms, some people have pain that goes down the leg and bruising immediately after a bone marrow procedure. It goes away as the body heals.

Getting Your Test Results

The time it takes to receive bone marrow biopsy results varies from a few days to a few weeks.

The results may help to:

• Reveal the presence of certain cancers like leukemia, lymphoma and myeloma
• Show whether cancer has spread
• Pinpoint the cancer stage
• Help doctors determine if certain cancer treatments are working
• Evaluate whether treatments such as chemotherapy are damaging bone marrow
• Diagnose low blood count conditions, such as anemia, thrombocytopenia and neutropenia
• Identify if an infection is present in the bone marrow

The compassionate cancer care experts at City of Hope^® consult with all patients individually to help them understand their results and provide information and feedback that empower loved ones and patients alike to make informed, collaborative health care decisions.