A bone marrow biopsy is a medical procedure that collects and examines samples of bone marrow, the soft, spongy tissue found inside certain bones. This tissue produces most of the body’s blood cells. The procedure serves as a diagnostic tool, providing valuable insights into conditions affecting the blood and bone marrow.
Preparing for the Biopsy
Patients receive specific instructions before a bone marrow biopsy. Discuss your complete medical history, including all medications, vitamins, and supplements, especially blood thinners, with your healthcare team. Your provider will advise if you need to temporarily stop certain medications to reduce bleeding risk. Fasting may be required if sedation is administered.
Pain management options are discussed to ensure comfort. A local anesthetic is injected to numb the biopsy site; additional sedation may be offered to help you relax, particularly if you experience anxiety. If you receive sedation, arrange for someone to drive you home afterward, as you may feel drowsy. Informed consent will also be obtained, ensuring you understand the procedure and its potential risks.
The Biopsy Procedure
The bone marrow biopsy is performed in an outpatient setting and takes around 30 minutes. The most frequent site for the biopsy is the posterior iliac crest, located at the back of the hip bone. Patients are positioned on their side or stomach, with knees slightly flexed, for optimal access.
Once positioned, the skin over the biopsy site is thoroughly cleaned with an antiseptic solution and draped to maintain a sterile field. A local anesthetic is then injected into the skin, subcutaneous tissue, and down to the surface of the bone to numb the area. You might feel a brief sting or burning sensation as the numbing medication is administered, but the area will soon become numb. A small incision may be made at the site to facilitate needle insertion.
The procedure involves two steps: aspiration and core biopsy. For the aspiration, a hollow needle is inserted through the numbed skin and into the bone marrow. A syringe is then attached to the needle to withdraw a small amount of liquid bone marrow. During this step, you may experience a sharp sting or a pulling sensation as the fluid is drawn.
Following the aspiration, the needle may be removed, or a different needle is used to obtain a core biopsy. This involves inserting a slightly larger, specialized needle to collect a small, cylindrical piece of solid bone marrow tissue. You may feel pressure or a dull, aching sensation as the core sample is obtained. After the samples are collected, the needle is removed, and firm pressure is applied to the site to control any bleeding.
After the Biopsy
Immediately following the bone marrow biopsy, pressure is applied to the site to stop bleeding, and a sterile dressing is placed over the wound. If you received sedation, you will need time to recover from its effects and should not drive yourself home. It is normal to experience mild discomfort, soreness, or aching at the biopsy site for a few days.
Over-the-counter pain relievers, such as acetaminophen, can help manage this pain. Applying an ice pack can also reduce soreness. Keep the dressing clean and dry for at least 24 hours.
Most people can return to light activities the day after the procedure, but strenuous exercise, heavy lifting, swimming, or soaking in a bathtub should be avoided for 24-48 hours or until the site has healed. Monitor the biopsy site for any signs of complications, such as excessive bleeding, increased redness, swelling, warmth, unusual drainage, or fever. If any of these symptoms occur, you should contact your healthcare provider promptly.
What the Biopsy Reveals
After bone marrow samples are collected, they are sent to a specialized laboratory for analysis. Pathologists, who are medical doctors specializing in diagnosing diseases, examine the samples under a microscope. They look for information including the cellularity of the marrow, which refers to the proportion of blood-forming cells compared to fat cells.
The laboratory analysis identifies the types and numbers of different blood cells present, such as red blood cells, white blood cells, and platelets, and assesses their maturity and appearance. The samples can also reveal abnormal cells, infections, or other conditions affecting the bone marrow. Further specialized tests, such as chromosomal analysis or molecular studies, may be performed to detect genetic abnormalities or specific markers related to certain diseases. These findings provide healthcare providers with a comprehensive picture of bone marrow health, important for diagnosing blood disorders and cancers, staging diseases, and guiding treatment decisions.