Bone Marrow Aspiration and Biopsy

What is bone marrow aspiration and biopsy?

Bone marrow aspiration and biopsy are procedures used to take samples of bone marrow for testing. Bone marrow is the soft, spongy tissue inside most bones.

Bone marrow works like a blood cell factory. It makes blood-forming (hematopoietic) stem cells that develop into:

• Red blood cells (which carry oxygen)
• Platelets (which help the blood clot)
• White blood cells (which fight infection)

Bone marrow has a liquid part and a more solid part. In a bone marrow aspiration, a small sample of liquid bone marrow is removed using a thin, hollow needle attached to a syringe. During a bone marrow biopsy, the care team will insert a larger needle into the same area to remove a small piece of bone tissue with enclosed marrow.

Many patients will have a bone marrow aspiration and biopsy at the same time.

Benefits of bone marrow aspiration and biopsy

Bone marrow tests may be used to:

• See if the bone marrow is producing enough of certain blood cells
• Diagnose certain medical conditions, such as blood disorders, cancers, and infections
• Find out if cancer has spread from other parts of the body to the bone marrow
• See if bone marrow is responding to treatments
  

What to expect during a bone marrow aspiration and biopsy

Your child may also have general anesthesia or sedation medicines during the procedure. Be sure your child follows fasting guidelines, or rules for eating and drinking before having the test.  

 Steps of a bone marrow aspiration and biopsy usually include:

1. A care team member may apply a local anesthetic or numbing medicine, either a cream or an injection, at the procedure site.
   
2. Your child will usually lie on their side.
   
3. The person performing the procedure will feel your child’s lower back to find the right spot for the test.
   
4. The area will be cleaned with a germ-killing liquid. The liquid will feel cold. Then, the health care provider might place plastic towels over the back, leaving only a small area of skin showing.
   
5. The care team member will insert the needle, which is attached to a syringe. Your child will feel some hard pushing if they are awake.
   
6. The care team member will pull some liquid marrow (which looks like blood) into a syringe. If awake, your child may feel some quick, sharp pain for an instant.
   
7. It is not unusual for the care team to attach more than 1 syringe if more samples are needed. Your child’s body will quickly replace the small amount of the fluid that has been removed.
   
8. The care team member will take out the needle, clean the area, and put on a bandage.
   

Samples are usually taken from the hipbone. If both an aspiration and biopsy are done, a separate needle is used for each procedure. The biopsy is usually done right before or after the aspiration. The total time for both procedures is usually about 30 minutes.

After the bone marrow aspiration and biopsy

A member of your child’s care team will update you about the procedure after it is completed. If your child had general anesthesia or sedation, they will spend time in a recovery area.

Your child may have soreness at the biopsy site. Most patients can return to usual activities after 24 hours.

Your care team will let you know:

• How to care for the area where the needle was inserted
• Ways to relieve any soreness or discomfort after the procedure
• What activities your child should avoid and for how long

Contact your care team if you notice any problems or signs of infection, including:

• Chills or fever
• Continued bleeding at the site where the needle was inserted
• Redness, swelling, oozing, or a bad smell at the site where the needle was inserted

The bone marrow samples will be sent to a lab for testing. A member of your care team will discuss the results with you.

Possible risks of bone marrow aspiration and biopsy

Your care team tries to make sure the procedure is as safe as possible. Possible risks or complications of a bone marrow aspiration and biopsy include:

• Bleeding at the site where the needle is inserted
• Infection
• Pain or discomfort
• Bruising
• Damage to nearby blood vessels or nerves
• Allergic reaction to the anesthesia or other medicines
• Failure to get a big enough sample. In this case, another procedure is required.

Discuss any concerns with your care team.

Questions to ask your care team

• Why does my child need a bone marrow biopsy or aspiration?
• Will my child have general anesthesia or sedation for the procedure?
• How long will the procedure take?
• Will my child have pain during or after the bone marrow tests?
• Who should we call if we have questions or problems afterward? 
• How and when will we know the results of the tests?

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