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Bone Marrow Biopsy – Procedure, Risks and Results

A bone marrow biopsy is a diagnostic procedure in which a small sample of tissue is taken from inside a bone. It is used to diagnose blood disorders, cancers, and other conditions affecting the bone marrow.

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Things worth knowing about "Bone Marrow Biopsy"

A bone marrow biopsy is a diagnostic procedure in which a small sample of tissue is taken from inside a bone. It is used to diagnose blood disorders, cancers, and other conditions affecting the bone marrow.

What Is a Bone Marrow Biopsy?

A bone marrow biopsy is a medical procedure in which a small sample of tissue is removed from the spongy interior of a bone. Bone marrow is the soft, fatty tissue found inside bones where blood cells are produced. By examining this tissue under a microscope, doctors can detect and evaluate diseases affecting the blood, lymphatic system, and bone marrow.

A bone marrow biopsy is often performed alongside a bone marrow aspiration, in which liquid bone marrow is drawn out with a syringe. Together, these two procedures provide comprehensive information about the cellular composition and function of the bone marrow.

When Is a Bone Marrow Biopsy Performed?

A bone marrow biopsy is used in a variety of clinical situations. Common indications include:

Suspected leukemia (blood cancer) or lymphoma
Investigation of unexplained anemia (low red blood cell count)
Diagnosis and monitoring of multiple myeloma
Evaluation of thrombocytopenia (low platelet count) or leukopenia (low white blood cell count)
Staging (determining the spread) of certain cancers
Diagnosis of myelodysplastic syndromes (MDS)
Assessment of storage diseases such as Gaucher disease

How Is a Bone Marrow Biopsy Performed?

The procedure is most commonly performed at the posterior iliac crest (the back of the hip bone), as this area is easily accessible and contains a sufficient amount of bone marrow. Less commonly, the anterior iliac crest or the sternum (breastbone) may be used.

Procedure Steps

The patient lies face down or on their side.
The skin and underlying tissue are numbed with a local anesthetic.
A special hollow needle is inserted through the skin and into the bone marrow.
Using a rotating motion, a small core of tissue (approximately 1 to 2 cm in length) is extracted.
The sample is then sent to a laboratory for microscopic analysis.

The entire procedure typically takes between 15 and 30 minutes. General anesthesia is not required, although mild sedation may be offered if needed.

Pain and Tolerability

Many patients find the bone marrow biopsy uncomfortable but manageable. Local anesthesia minimizes pain during the procedure. Patients may feel pressure or a brief sharp sensation when the needle is inserted and the sample is taken. Mild soreness and tenderness at the biopsy site are common for a few days afterward.

Risks and Complications

A bone marrow biopsy is a safe procedure with a low risk of complications. Possible, though rare, complications include:

Bleeding at the biopsy site
Infection at the wound site
Temporary pain and swelling
Very rarely: injury to surrounding structures

Patients with clotting disorders or certain medical conditions should inform their doctor before the procedure.

Results and Interpretation

The tissue sample is examined using histological (tissue microscopy), cytological (cell microscopy), immunohistochemical, and sometimes genetic methods. Results are typically available within a few days to two weeks. They provide information about:

The composition and maturity of blood cells
The presence of tumor cells or metastases
Inflammatory or fibrotic changes in the bone marrow
Genetic abnormalities relevant to treatment planning

References

Bain, B.J. - Bone Marrow Pathology, 5th edition. Wiley-Blackwell, 2019.
National Cancer Institute (NCI) - Bone Marrow Aspiration and Biopsy. Available at: https://www.cancer.gov
Swerdlow, S.H. et al. - WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC Press, Lyon, 2017.

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