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A bone marrow biopsy is the removal of soft tissue from inside bone. Bone marrow grows inside some of the larger bones in the body. It produces platelets and red and white blood cells.

The bone marrow biopsy may be done in the health care provider's office or in a hospital. The sample is usually taken from the hip bone. The skin is cleansed, and a local anesthetic is injected to numb the skin.

The biopsy needle is then inserted into the bone. The center of the needle is removed and the needle is moved deeper into the bone. This creates a tiny sample, or core, of bone marrow within the needle. The needle is then removed, along with the bone marrow sample. Pressure is applied to the biopsy site to stop bleeding, and a bandage is applied.

An aspirate may also be performed, usually before the biopsy is taken. After the skin is numbed, the aspirate needle is inserted into the bone, and a syringe is used to withdraw the liquid bone marrow. If this is done, the needle will be removed and either repositioned, or another needle may be used for the biopsy.

Tell the health care provider:

• If you are allergic to any medications
• What medications you are taking
• If you have bleeding problems
• If you are pregnant

You must sign a consent form.

You will feel a sharp sting when the numbing medicine is injected. You may feel a brief, sharp pain when the liquid (aspirate) is removed.

The biopsy needle may also cause a brief, usually more dull, pain. Since the inside of the bone cannot be numbed, this test may cause some discomfort. However, not all patients have such pain.

Your doctor may order this test if you have abnormal types or numbers of red or white blood cells on a complete blood count. It may also be done to check for other diseases in the bone marrow, (including cancer), or certain types of anemia.

It may also be done to see how well a person responds to treatment for certain cancers.

The marrow has normal cells that are the correct types and numbers.

Abnormal results may be due to cancers of the bone marrow (leukemia or Hodgkin's disease).

The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).

Additional conditions under which the test may be performed:

• Disseminated coccidioidomycosis
• Hairy cell leukemia
• Hodgkin's lymphoma
• Idiopathic aplastic anemia
• Multiple myeloma
• Neuroblastoma
• Non-Hodgkin's lymphoma
• Polycythemia vera
• Primary amyloid
• Primary myelofibrosis
• Primary thrombocythemia
• Secondary aplastic anemia
• Secondary systemic amyloid

Persistent bleeding and infection are rare and can be controlled.

This test is often performed when there are problems with the various types of blood cells. The person may be at increased risk for bleeding, infection, or other problems.

Biopsy - bone marrow

McPherson RA and Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: WB Saunders; 2007:478-81.

Hoffman R, Benz Jr. EJ, Shattil SJ, et al., eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Churchill Livingston; 2005:2657.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.