Bone marrow biopsy

Answer 1

Definition

A bone marrow biopsy is the removal of soft tissue from inside bone. Bone marrow grows inside some of the larger bones in the body. It produces platelets and red and white blood cells.

Alternative Names

Biopsy - bone marrow

How the test is performed

The bone marrow biopsy may be done in the health care provider's office or in a hospital. The sample is usually taken from the hip bone. The skin is cleansed, and a local anesthetic is injected to numb the skin.

The biopsy needle is then inserted into the bone. The center of the needle is removed and the needle is moved deeper into the bone. This creates a tiny sample, or core, of bone marrow within the needle. The needle is then removed, along with the bone marrow sample. Pressure is applied to the biopsy site to stop bleeding, and a bandage is applied.

An aspirate may also be performed, usually before the biopsy is taken. After the skin is numbed, the aspirate needle is inserted into the bone, and a syringe is used to withdraw the liquid bone marrow. If this is done, the needle will be removed and either repositioned, or another needle may be used for the biopsy.

How to prepare for the test

Tell the health care provider:

• If you are allergic to any medications
• What medications you are taking
• If you have bleeding problems
• If you are pregnant

You must sign a consent form.

How the test will feel

You will feel a sharp sting when the numbing medicine is injected. You may feel a brief, sharp pain when the liquid (aspirate) is removed.

The biopsy needle may also cause a brief, usually more dull, pain. Since the inside of the bone cannot be numbed, this test may cause some discomfort. However, not all patients have such pain.

Why the test is performed

Your doctor may order this test if you have abnormal types or numbers of red or white blood cells on a complete blood count. It may also be done to check for other diseases in the bone marrow, (including cancer), or certain types of anemia.

It may also be done to see how well a person responds to treatment for certain cancers.

Normal Values

The marrow has normal cells that are the correct types and numbers.

What abnormal results mean

Abnormal results may be due to cancers of the bone marrow (leukemia or Hodgkin's disease).

The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).

Additional conditions under which the test may be performed:

• Disseminated coccidioidomycosis
• Hairy cell leukemia
• Hodgkin's lymphoma
• Idiopathic aplastic anemia
• Multiple myeloma
• Neuroblastoma
• Non-Hodgkin's lymphoma
• Polycythemia vera
• Primary amyloid
• Primary myelofibrosis
• Primary thrombocythemia
• Secondary aplastic anemia
• Secondary systemic amyloid

What the risks are

Persistent bleeding and infection are rare and can be controlled.

Special considerations

This test is often performed when there are problems with the various types of blood cells. The person may be at increased risk for bleeding, infection, or other problems.

References

McPherson RA and Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: WB Saunders; 2007:478-481.

Hoffman R, Benz Jr. EJ, Shattil SJ, et al., eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Churchill Livingston; 2005:2657.

Answer 2

Definition

A bone marrow biopsy is the removal of soft tissue, called marrow, from inside bone. Bone marrow is found in the hollow part of most bones. It helps form blood cells.

Alternative Names

Biopsy - bone marrow

How the test is performed

A bone marrow biopsy may be done in the health care provider's office or in a hospital. The sample is usually taken from the hip bone. The health care provider will clean the skin and inject a numbing medicine into the area. Rarely, you may be given medicine to help you relax.

The doctor inserts the biopsy needle into the bone. The center of the needle is removed and the hollowed needle is moved deeper into the bone. This captures a tiny sample, or core, of bone marrow within the needle. The sample and needle are removed. Pressure and a bandage is applied to the biopsy site.

A bone marrow aspirate may also be performed, usually before the biopsy is taken. After the skin is numbed, the needle is inserted into the bone, and a syringe is used to withdraw the liquid bone marrow. If this is done, the needle will be removed and either repositioned, or another needle may be used for the biopsy.

How to prepare for the test

Tell the health care provider:

• If you are allergic to any medications
• What medications you are taking
• If you have bleeding problems
• If you are pregnant

You must sign a consent form.

How the test will feel

You will feel a sharp sting when the numbing medicine is injected. You may feel a brief, sharp pain when the liquid (aspirate) is removed.

The biopsy needle may also cause a brief, usually more dull, pain. Since the inside of the bone cannot be numbed, this test may cause some discomfort. However, not all patients have such pain.

Why the test is performed

Your doctor may order this test if you have abnormal types or numbers of red or white blood cells or platelets on a complete blood count(CBC).

This test is used to diagnose leukemia, infections, some types of anemia, and other blood disorders. It may also be used to help determine if a cancer has spread or responded to treatment.

Normal Values

A normal result means the bone marrow contains the proper number and types of blood-forming (hematopoietic) cells, fat cells, and connective tissues.

What abnormal results mean

Abnormal results may be due to cancers of the bone marrow (leukemia or Hodgkin's disease).

The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).

Additional conditions under which the test may be performed:

• Disseminated coccidioidomycosis
• Hairy cell leukemia
• Hodgkin's lymphoma
• Idiopathic aplastic anemia
• Multiple myeloma
• Neuroblastoma
• Non-Hodgkin's lymphoma
• Polycythemia vera
• Primary amyloid
• Primary myelofibrosis
• Primary thrombocythemia
• Secondary aplastic anemia
• Secondary systemic amyloid

What the risks are

There may be some bleeding at the puncture site. More serious risks, such as serious bleeding or infection, are very rare.

Special considerations

This test is often performed when there are problems with the various types of blood cells. The person may be at increased risk for bleeding, infection, or other problems.

References

McPherson RA and Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: WB Saunders; 2007:478-481.

Hoffman R, Benz Jr. EJ, Shattil SJ, et al., eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Churchill Livingston; 2005:2657.

Reviewed By

Review Date: 06/02/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.