Bone marrow biopsy

Bone marrow is the soft, spongy tissue inside your bones. It makes your red blood cells, white blood cells and platelets. When blood tests show too many, too few or abnormal blood cells, looking at the marrow itself often gives the answer.

The test usually has two parts, done through the same small puncture. The aspiration draws out a few teaspoons of liquid marrow. The biopsy takes a thin core of solid marrow about the width of a pencil lead. Both come from the back of the hip bone, called the posterior iliac crest, because the marrow there is rich and the bone is close to the skin.

What we see

Your hematologist (blood specialist) or oncologist orders the test and decides which lab studies to run, such as flow cytometry, chromosome and genetic tests. There is no scan or blood test that fully replaces a marrow sample for these questions.

This is the question almost everyone asks, and it deserves a straight answer. Bone marrow biopsies have a reputation for hurting, mostly from tests done at the bedside with numbing medicine only. The bone surface can be numbed, but the marrow inside cannot, so there are a few moments of deep discomfort.

In our practice the biopsy is done at El Camino Hospital with moderate (twilight) sedation and CT guidance. Sedation makes you relaxed and drowsy, and many people remember little of the procedure. CT lets us place the needle precisely, which can mean fewer attempts. You can choose numbing medicine only if you prefer to drive yourself home.

Many of my patients come in anxious because a previous bone marrow biopsy was painful. I tell them honestly that the aspiration still causes a few seconds of deep ache, and I warn them just before it happens. With sedation and good numbing of the bone surface, most tell me afterward it was far easier than last time.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

More tips are in before your procedure and sedation.

1. 1
   Getting ready

   A nurse starts an IV and connects heart, blood pressure and oxygen monitors. You lie on your stomach on the CT table.

2. 2
   Planning

   A low-dose CT scan shows the back of the hip bone. We clean the skin, give sedation and numb the skin and the surface of the bone.

3. 3
   Taking the samples

   We guide a hollow needle into the bone. We draw out liquid marrow for the aspiration, then take a small core of solid marrow for the biopsy.

4. 4
   Finishing up

   We remove the needle, press on the site for a few minutes and seal it with skin glue.

1. First 30–60 minutes
   Rest in recovery, often lying on your back to press on the site. You can eat, drink and see family.
2. Rest of the day
   Take it slow. No driving or alcohol if you had sedation. You can shower after 24 hours.
3. Days 1–3
   Mild soreness in the lower back or hip. Most people return to normal activities the next day.
4. About 1 week
   Avoid baths, hot tubs and swimming until the site heals. Skin glue falls off in 1 to 2 weeks.

An ice pack and acetaminophen (Tylenol) usually control the soreness. If your platelets are low, ask before using ibuprofen.

First results often come in about 2 business days. Genetic and chromosome studies can take 1 to 3 weeks. Your hematologist or oncologist will review them with you.

Bone marrow biopsy is one of the safest biopsies. Serious bleeding and infection each happen in fewer than 1 in 100 people. Bleeding is slightly more likely if your platelets are very low. Nerve irritation and injury to nearby structures are very rare, and CT guidance helps us avoid them. Some people feel lightheaded briefly after sedation.