I Need a Bone Marrow Biopsy, What Does That Mean?

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One of the common diagnostic tests for various blood disorders is the bone marrow biopsy. Hearing that you or your child needs to have a bone marrow biopsy may be scary, especially if you don't understand what that means. Let's take a minute to review the different components of this important test.

Although commonly referred to as the bone marrow biopsy, this procedure actually has two parts.  he first part is the bone marrow aspirate.

This is the liquid portion of the bone marrow which looks similar to blood. The bone marrow biopsy is the removal of a small part of the bone marrow.  

Why Do I Need a Bone Marrow Biopsy? 

First things first, needing a bone marrow biopsy does not necessarily mean that you or your child has cancer. A bone marrow biopsy is required to diagnosis leukemia, but there are numerous benign conditions where bone marrow biopsy is required for diagnosis too. It is a common test used to diagnose inherited bone marrow failure syndromes like Fanconi Anemia or Diamond Blackfan Anemia. It is also a common test in the work-up of neutropenia (low neutrophil count). Cyclic neutropenia and severe congenital neutropenia have very classic bone marrow features. Because of the many reasons this test may be needed, it is important for you to discuss with your physician why he or she wants to perform this test.  

Do Bone Marrow Biopsies Hurt? 

One of the most common questions I am asked is, "Will it hurt?" That is a difficult question to answer.

Children usually undergo the procedure with anesthesia so they have no pain during it. Afterward, most children have almost no pain.  

Adults generally are awake during the procedure with anesthesia only in the skin/area near the biopsy site. In this case, the insertion of the needle and aspirate (removal of liquid portion of the bone marrow) can cause brief but significant pain.

If a biopsy is also needed, you will feel pain as the needle is pushed into the bone. Some discomfort or pain is also considered normal after the procedure. In general though, this pain is mild and treatable with over the counter pain relievers like acetaminophen.  

Where Is the Biopsy Taken From?

atients and families also usually ask, "Where is the biopsy taken from?" The most common areas are the hips. This procedure can be performed on the anterior hip (front of hip) or posterior hip (back of hip). The area of the hip selected is determined by the health of the patient. For example, are they too sick to lay on their side for a posterior hip marrow? The preference of the provider performing the procedure is also taken into account.  

Additionally, bone marrow aspirates and biopsies can be drawn from one hip (unilateral) or both hips (bilateral). In general, bone marrow biopsies for benign blood disorders are bilateral.

In very small children, getting a sample from the hip can be challenging.

In this circumstance, a sample is drawn from the tibia, one of the lower leg bones). In rare circumstances, a bone marrow aspirate (not biopsy) may be drawn from the sternum (breastbone).  

What Can I Expect During the Procedure?

During the procedure, the area where the bone marrow is sampled is cleaned very thoroughly. The needles used are sterile. After cleaning the area, local anesthesia will be injected into the area of the procedure. This may not be done if you are receiving general anesthesia.  

During the bone marrow aspirate, a needle is placed in the bone, then the liquid portion of the bone marrow is collected in a syringe similar to having blood drawn from a vein. Sometimes several different tubes are needed but this does not require much aspirate, usually only a couple of tablespoons.  

After the aspirate, a slightly larger, hollow needle is placed into the bone to remove a small piece. About 2 cm (a little less than one inch) of bone marrow is preferred in adults with less being required in children. After the needle is removed, the area is cleaned and a bandage is placed.  

What happens to the samples? Both the aspirate and biopsy are sent to review by a pathologist. The aspirate is placed on glass slides, stained, and reviewed under the microscope. The aspirate can also undergo many other tests like flow cytometry and cytogenetics to help in the diagnostic process. The biopsy is cut into very thin slices and placed on slides to be reviewed under the microscope. Once all the results have come back (several days to weeks) your physician should review them with you.  

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