Bone marrow aspiration and bone marrow biopsy are medical procedures commonly used in leukemia diagnosis, treatment, and follow-up care. Both procedures are performed to collect a small sample of tissue to assess the health of the bone marrow and the blood cells it contains.

Lab results on tissue obtained from a bone marrow exam can indicate the presence, type, and prognosis of leukemia. The results also help guide cancer treatment decisions, among other potentially life-saving health insights.

What Are Bone Marrow Aspiration and Biopsy?

Bone marrow is a spongy tissue that comprises both liquid and solid components. Aspiration is a procedure to remove the liquid tissue. Solid tissue is removed via biopsy.

Bone marrow aspiration and biopsy are usually performed by a physician with a hematology (blood) or oncology (cancer) specialty or a specially trained technician. The bone marrow tissue samples are then analyzed under a microscope by a pathologist. Additional tests, including minimal residual disease testing, may also be performed on samples.

Bone marrow aspiration and biopsy are usually simple, quick, outpatient procedures that can be done in a doctor’s office. They can also be performed in a clinic or at a hospital. On average, a combined bone marrow aspiration and biopsy takes about 30 minutes. A bone marrow biopsy alone usually takes 10 to 20 minutes.

Why Is Bone Marrow Collected?

A bone marrow aspiration and biopsy can be used to diagnose, treat, type, and measure leukemia cells. A bone marrow biopsy can also give insights into the structure of the bone marrow cells. Bone marrow exams can sometimes provide detailed information that a blood test cannot, or earlier than a blood test would show results.

Bone marrow aspiration and biopsy can:

• Determine the cause of irregular blood count, for example, anemia (low red blood cell count) or leukopenia (low white blood cell count)
• Diagnose and stage leukemia
• Obtain genetic information, including chromosomal abnormalities, to determine leukemia type and help guide treatment
• Measure how effective a person’s leukemia treatment is by seeing how much function their bone marrow has regained
• Collect bone marrow for a stem cell transplant, a leukemia treatment in which a person receives healthy blood-forming stem cells

Risks of Bone Marrow Biopsy and Aspiration

Approximately 1 in 1,000 people who undergo a bone marrow test will experience one of the following possible complications:

• Excessive bleeding — Bleeding too much is a concern in people with bleeding disorders or in those who have low platelet counts (thrombocytopenia).
• Infection — The risk of infection at the incision or injection site is higher in people with weakened immune systems or who are immunocompromised.
• Damage to the heart or lungs — Although this rarely happens, if bone marrow is collected from the breastbone (sternal aspiration), the needle can damage the heart or lungs.

How Are Bone Marrow Aspiration and Biopsy Performed?

Bone marrow biopsies are only performed on the hip bone. Bone marrow exams are usually conducted on the pelvic bone, where the hips and lower back meet. Rarely, bone marrow aspirations are performed on the breastbone or sternum (called sternal aspiration). In young children and infants, bone marrow aspirations may be performed on the tibia (lower leg bone) just below the knee.

Before the Procedure

The doctor or a member of their team will likely have some paperwork for you to complete, such as giving consent to perform the procedure. They usually take basic vital signs such as heart rate and blood pressure. This is a good opportunity to ask any remaining questions about the procedure or recovery. The National Cancer Society has a great resource to help you ask your treatment team all the right questions.

Some clinicians offer a sedative (calming medication) before bone marrow collection. If you are feeling nervous or anxious about the procedure, you can ask your health care provider if they will provide one.

If the procedure is performed on the pelvis, the physician will either have you lie on your stomach or your side with your knees tucked into your chest. If it’s a sternal aspiration, you will likely lie flat on your back.

During the Procedure

The skin on the bone marrow extraction site is first cleaned and disinfected using antiseptic, and the site of the extraction is marked. Then, using a small needle to inject anesthesia, the area is numbed to block any pain. It may sting or burn for a couple of seconds when the local anesthesia is first administered.

During aspiration, a hollow needle is inserted into the hip bone, a syringe is attached, and a small amount of the liquid of the bone marrow (aspirate) is drawn into the syringe.

For the biopsy, a small incision (2 to 3 millimeters), is made. Next, a piece of solid bone marrow tissue is cored from the bone using a larger hollow needle. When performed together, the bone marrow aspiration is generally done before the biopsy. Some doctors perform both procedures with a single needle.

After the Procedure

The doctor will cover the extraction site with a sterile dressing or bandage. You’ll likely be asked to apply pressure to the site for 15 to 20 minutes. This covering should stay on and be kept dry for 24 to 48 hours. Thereafter, you can use a standard Band-Aid until the site is fully healed. The site should be fully healed in one to two weeks.

Some physicians have you recuperate on site for up to 60 minutes after the procedure, in the very unlikely event that post-procedure issues arise. If only local anesthetic was used, you should be able to walk out of your appointment and see yourself home once your health care provider releases you. If your procedure was done under sedation, you will be unable to drive afterward, so make arrangements to get home safely.

What Does Bone Marrow Collection Feel Like?

Although a little pain is to be expected, sometimes even with local anesthesia, bone marrow exams should not be debilitating. Some MyLeukemiaTeam members compared the pain to a toothache. Many people report hearing a “crunching sound” and feeling a sharp pain when the needle enters the bone followed by pressure.

Here’s what some members of MyLeukemiaTeam had to say about their bone marrow aspirations and biopsies:

• “It’s really not that bad. I’ve had bone marrow tests both with and without sedation. I prefer the latter.”
• “The benefit of no sedation is you don’t need a designated driver. The downside: you can hear the drill.”
• “I think the sound of the drill caused me more anxiety than the pain.”
• “My biopsy was very painful.
• “They numbed it and it still burnt like fire!”
• “It’s not bad. I’ve had four — two without sedation and two with.”

Recovery From a Bone Marrow Collection

Mild discomfort or low-grade pain at and around the biopsy site is common, especially as the anesthesia’s numbing effects wear off. Some people report tingling down the back of their legs. This sensation may last a couple of days. Some bruising around the area is also a common side effect and may only become visible a few days after the procedure.

Try cold compresses or over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatories like ibuprofen or naproxen to help alleviate the discomfort.

Contact Your Doctor If …

If you experience any of the following symptoms, there may be an issue after a bone marrow exam. Contact the doctor who did your procedure if you experience:

• Fever
• Continued or excessive bleeding from the incision
• Unusual discharge from the insertion site
• Severe pain at the needle insertion point after the first day or two
• Pain that doesn’t improve or continues for more than five days

Find Your Team

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. On MyLeukemiaTeam, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Have you undergone a bone marrow aspiration and biopsy? Do you have tips for others who may experience these procedures? Share your story in the comments below, or start a conversation by posting on your Activities page.