Bone Marrow Aspiration and Biopsy

Bone marrow aspiration and biopsy are commonly used to diagnose and evaluate blood disorders. These procedures collect bone marrow fluid or tissue to assess blood-forming cells, abnormal cells, and the overall structure of the bone marrow.

Bone marrow aspiration collects liquid marrow for tests such as cell morphology, flow cytometry, chromosome analysis, and genomic testing. A bone marrow biopsy removes a small core of tissue, allowing the structure, cellularity, fibrosis, and abnormal cell infiltration of the marrow to be evaluated. Because the two procedures provide different information, they are sometimes performed together.

Bone marrow examination plays an important role in the diagnosis, classification, and response assessment of diseases such as leukemia, multiple myeloma, and myelodysplastic syndromes (MDS). It may also be used in selected patients with lymphoma to evaluate bone marrow involvement.

Bone marrow aspiration and biopsy are used mainly for blood cancers and other hematologic disorders. They may be recommended when blood tests show unexplained abnormalities in white blood cells, red blood cells, or platelets, or when conditions such as leukemia, MDS, or multiple myeloma are suspected.

For patients with a diagnosed blood cancer, bone marrow testing may also be used to assess remission, monitor treatment response, or evaluate possible relapse. In some leukemias, bone marrow samples are used for measurable residual disease (MRD) testing to detect small numbers of cancer cells that may remain after treatment.

Bone marrow examination is not routinely required for most solid tumors. It may be considered when bone marrow involvement is suspected or when unexplained blood count abnormalities require further evaluation.

Bone marrow aspiration and biopsy are usually performed using the iliac crest at the back of the pelvis. The patient generally lies on the side or stomach, and the area is cleaned and numbed with local anesthetic before a needle is inserted into the bone marrow.

During aspiration, a small amount of liquid bone marrow is withdrawn. Some patients experience brief pressure or a sharp aching sensation during this step. During biopsy, a specialized needle is used to remove a small core of bone marrow tissue.

Depending on the disease, the samples may be used for morphology, pathology, flow cytometry, chromosome analysis, FISH, genomic testing, or other molecular studies.

Bone marrow aspiration and biopsy are invasive procedures, but the overall risk is generally low. Temporary pain, soreness, or minor bleeding may occur at the procedure site. Less commonly, patients may develop a local hematoma or infection.

Before the procedure, patients should tell their healthcare team about anticoagulant or antiplatelet medications and any known bleeding or clotting problems. Patients with very low platelet counts or an increased risk of bleeding may require additional assessment and precautions.

Bone marrow findings are interpreted together with peripheral blood tests, flow cytometry, chromosome analysis, and molecular studies. A single bone marrow examination may not answer every clinical question, and some patients with blood cancers need repeat testing at different stages of treatment to monitor their disease.