What Is a Bone Marrow Biopsy?

Medically reviewed by Marla Anderson, MD

A bone marrow biopsy is a medical test where a healthcare provider removes a small sample of cells from your bone marrow—the soft tissue at the center of your bone where most of your blood cells are made. In most cases, your provider will remove the cells from your hip or sternum The biopsy is usually taken from your pelvis or sternum (breastbone). Once your provider collects your blood cells, they will send the sample to a lab to examine the blood for abnormal cell counts or types.

Purpose

The main reason your healthcare provider would order a bone marrow biopsy is to diagnose a blood disorder or disease—such as leukemia, multiple myeloma, lymphoma, myelodysplastic syndrome, and unexplained anemia. Your provider may also use a bone marrow biopsy to learn what stage of an underlying blood disorder you're in and whether treatment for your condition is effective.

How Does It Work?

A bone marrow biopsy can be completed in your healthcare provider's office, a hospital, or at another outpatient facility. Knowing what to expect before, during, and after your test can help ease any worries you have and come to the procedure prepared.

Before the Test

Before the test begins, your healthcare provider will go over how the bone marrow biopsy will work, the risks, and what the results mean. Now is also a good time to ask any questions you have before the procedure begins. Once you understand the process, your provider will ask you to sign a consent form to ensure that you are OK with getting the biopsy.

If you are pregnant, taking any medications or supplements, are allergic to any medications, or have a condition that prevents your blood from clotting, it's important to tell your provider this information—as these concerns can potentially affect the safety of your procedure.

When you are ready for the exam, you will wear a hospital gown so that the area of your body that is receiving the biopsy is easily accessible. Your provider will likely give you a mild sedative and numbing medicine to keep you relaxed, still, and comfortable during the procedure. Then, they'll instruct you to lie down on the exam table to start the biopsy.

During the Test

Your healthcare provider may gently tap on your hip to find the correct place to take the biopsy. If an imaging scan is helping guide the biopsy, the machine will be placed above or next to you. Then, your provider will insert a hollow needle into your body to remove a small sample of bone and bone marrow.

You may feel some pressure or discomfort when your provider inserts the needle into your bone. But, the numbing medicine should prevent you from feeling any extreme pain. If the procedure is too uncomfortable for you, it's important to tell your healthcare provider about your discomfort. Once the needle is in your body, your provider will take the sample from your bone and place the bone and bone marrow in a specimen container to complete the exam.

After the Test

When the biopsy is complete, your provider will clean the insertion site (the part of your body where the sample was taken from) and place a bandage over it to stop any bleeding. If your biopsy is an inpatient procedure, your healthcare team will take you to a hospital room to recover. If your biopsy is an outpatient procedure, you can go home shortly after the exam is over. If you receive any form of sedation, you will need to have a loved one drive you home.

After the procedure, your provider will send your sample to a pathologist (or, a doctor who specializes in diagnosing diseases in a lab). The pathologist tests your sample to check the size, shape, and number of your blood cells to determine if you have a blood disease or disorder. In some cases, your cells may also show genetic changes that are associated with certain diseases. Generally, you can expect these results back from your pathologist and healthcare provider within three weeks.

Risks and Precautions

While biopsies are common, these procedures do come with certain risks, such as:

• Infection at the insertion site

• Excessive bleeding (or hemorrhaging)

• Bruising and discomfort at the biopsy site
  

Before your procedure, it's important to tell your provider about which medications and supplements you're taking—especially if you're using aspirin, fish oil, or blood thinners, which may increase your risk of bleeding after the biopsy.

While a bone marrow biopsy is generally safe, you cannot get one done if you have a blood clotting disorder. If you're pregnant, your provider will likely not use any imaging equipment (such as an X-ray) to guide your biopsy.

How to Prepare for a Bone Marrow Biopsy

Understanding how to prepare for your biopsy can help you feel more at ease on the day of your procedure. Your healthcare provider will likely instruct you to stop taking any medications or supplements that interfere with blood clotting up to three days before your biopsy. They may also ask you to stop eating or drinking eight hours before the procedure. It can also help to call your insurance provider to ask what the out-of-pocket costs for your procedure will be.

On the day of your appointment, it may be helpful to:

• Bring your ID, insurance card, and any paperwork your provider gave you

• Wear comfortable clothing

• Avoid bringing jewelry or valuable items with you to your appointment

• Ask a loved one to drive you home after the procedure
  

Results

It can take anywhere from five days to three weeks to get your test results back—depending on what tests the pathologist completed with your sample. Once the pathologist completes a report of your results and sends it to your healthcare provider, your provider will contact you about your results via an online portal, phone call, or in-person appointment.

Interpreting Your Results

When you get your results back, your provider will explain what the pathologist found.

A normal result means all the cell types in your sample have a normal appearance and you have the correct number of each cell type. This means that there are no signs of an underlying disorder or disease.

If you receive an abnormal result, it may be caused by one or more of the following health conditions:

• Hairy cell leukemia: White blood cell cancer

• Non-Hodgkin lymphoma: Lymph tissue cancer

• Anemia: Inability to make enough healthy red blood cells

• Multiple myeloma: Plasma cell cancer

• Myelodysplastic syndrome: A group of disorders that cause a lack of healthy blood cells

• Neuroblastoma: Nerve tissue cancer

• Polycythemia vera: A bone marrow disease that increases blood cells

• Amyloidosis: An abnormal build-up of amyloid protein

• Myelofibrosis: A bone marrow disorder that replaces healthy bone marrow with fibrous scar tissue

• Thrombocythemia: Increases blood platelets in your bone marrow

• Thrombocytopenia: Decreases blood platelets in your bone marrow

• Leukopenia: Low white blood cell count

• Waldenström macroglobulinemia: A type of white blood cell cancer
  

Your results can also determine the stage of your blood or bone marrow cancer. If you are already undergoing cancer treatment, your results can show whether or not the treatment is working, which helps your provider understand if they should adjust your treatment plan.

A Quick Review

A bone marrow biopsy is a medical procedure that collects a small sample of your bone marrow and bone to look at your blood cells for abnormalities. Your healthcare provider will collect this sample of cells from your pelvis or sternum and send the sample to a pathologist for testing. The results of your bone marrow biopsy can indicate if you have a blood disorder or disease.

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