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Bone marrow biopsy and aspiration are procedures used to collect and test bone marrow---the soft, spongy tissue inside certain bones where blood cells are made. These tests are used to diagnose many different conditions that affect the blood and bone marrow, including leukemia, lymphoma, multiple myeloma, and many types of anemia.

What is the difference between bone marrow biopsy and bone marrow aspiration?

• Bone marrow aspiration involves removing a sample of the liquid part of the bone marrow.
• Bone marrow biopsy involves removing a sample of the solid part.

These procedures are usually both done together, but in some cases only one might be needed.

Why is a bone marrow biopsy and aspiration done?

To diagnose cancer or another disease

Bone marrow biopsy and aspiration are often done to help diagnose a disease affecting the bone or blood. These tests might be the next step after a physical exam or lab tests such as a complete blood count (CBC) shows something abnormal.

Bone marrow biopsy and aspiration are often used to diagnose cancers and cancer-related diseases such as:

• Ewing Sarcoma
• Leukemia
• Lymphoma
• Multiple Myeloma
• Myelodysplastic Syndromes
• Polycythemia vera and other myeloproliferative disorders
• Waldenstrom Macroglobulinemia

These procedures can also help in diagnosing other diseases affecting the blood and bone marrow, including:

• Aplastic anemia and other types of anemia (low red blood cells)
• Low iron or high iron
• Abnormal blood cell counts

To find out if treatment is working

Bone marrow biopsy and aspiration can also be used at certain times when someone is undergoing treatment to find out how well the treatment is working or to check if the disease has gotten worse (progressed).

How are bone marrow biopsy and aspiration done?

Usually, these procedures are done at the same time. The bone marrow aspiration, which uses a smaller needle, is done first, followed by the biopsy, using a larger needle. Most often, the aspiration and biopsy are done on the back of the hip bone (the posterior iliac crest). In rare cases, if only a bone marrow aspiration is needed, the breastbone might be used instead.

Bone marrow aspiration

• The skin over the back of the hip area is cleaned.
• The provider uses a needle to numb the area and the surface of the bone with a local anesthetic. This can cause a brief stinging or burning feeling to the area.
• The provider will make a small cut in the skin to allow passage of the needle used for the bone marrow aspiration.
• A thin, hollow needle is then inserted into the skin and bone.
• A syringe is then attached to the needle and used to suck out a small amount of liquid bone marrow. This may cause a brief, shooting pain might be felt at the area and leg, even with anesthetic. Multiple collections may be needed based on the testing to be done.
• Once the sample is collected, the needle is removed.
• The samples will be sent to the laboratory for testing.

Bone marrow biopsy

• Following bone marrow aspiration (if performed), a slightly larger, hollow needle is inserted into the bone. This can cause feelings of pressure as the needle is put into the proper location.
• A piece of the solid bone marrow is removed. This can cause brief pain at the area.
• Once the sample is collected, the needle is removed.
• Pressure will be put on the site over the area to help prevent bleeding after the biopsy is done.
• The samples will be sent to the laboratory for testing.

Is a bone marrow biopsy painful?

Bone marrow biopsy and aspiration procedures can be painful, but the level of pain is different for each person. Some people rate the overall pain as mild to moderate, while others report it being moderate or severe.

• For a bone marrow aspiration, many people describe the pain when the liquid sample is being removed as sharp, but short lived.
• Pain during a bone marrow biopsy is often duller and occurs when the sample of bone is removed. Some people even have anxiety before the procedure.

Medicines to help with pain and anxiety

Some people may find it helpful to take medication before the procedure (premedication) to help with pain or anxiety, such as:

• An opioid analgesic such as oxycodone or tramadol for pain
• A benzodiazepine such as lorazepam for anxiety

During the procedure, other medications may be used to numb the area or help keep you calm:

• Local anesthesia, such as lidocaine, is almost always used to numb the skin over the biopsy site
• Conscious sedation using an IV in the arm can be done in some cases to help you relax and feel drowsy.
• General anesthesia that makes the person completely unconscious is rarely done.

Other things that can help

• Using distraction and relaxation techniques during the procedure.

• Having a caregiver or a member of the cancer care team at the bedside to offer supportive comfort. 

What to expect on the day of your procedure

The bone marrow biopsy and aspiration procedure takes about 10-30 minutes, depending on the type of anesthesia used. If you are getting IV sedation, extra time will be needed.

Before the procedure

• Vital signs are checked.
• If needed, premedications will be given.
• You will usually be positioned on your stomach or lying on your side.

After the procedure

• A pressure dressing will be placed over the biopsy area.
• You will need to stay lying down for at least 10 to 15 minutes.
• The dressing will need to be kept dry and in place for 24 hours.
• If local anesthesia was given, usual daily activities can be restarted. If IV sedation is given, more time is needed to recover from feeling drowsy.
• It is best to have a driver available and take it easy for the rest of the day.

Recovering from a bone marrow biopsy and aspiration

• The biopsy area might be sore for about a week and there might be a bruise.
• Prescribed or over the counter pain medications can help manage any discomfort.
• Call your cancer care center or health care provider you have an increase in pain, bleeding, or swelling at the biopsy area.