Bone Marrow Biopsy tests

What is a bone marrow biopsy? 

A bone marrow biopsy is a procedure where a small sample of your bone marrow is taken using a needle, so that the bone marrow can be examined closely. 

The bone marrow is where your body makes stem cells, which develop into other types of blood cells, such as red blood cells, white blood cells and platelets. In aplastic anaemia, the bone marrow contains fewer cells than normal.  

When you have a bone marrow test there will be two types of biopsy carried out: an aspiration biopsy, and a trephine biopsy.  

An aspiration biopsy is performed by extracting a very small amount of liquid bone marrow using a syringe. A trephine biopsy is performed by extracting a small sample of the solid, spongy bone marrow using a needle. The trephine biopsy is used to analyse the number of cells and structure of the bone marrow and gives haematologists a detailed understanding about the condition of your bone marrow. 

Performing both types of biopsy at the same time will give your doctor a better picture of how your bone marrow is performing. 

Bone marrow biopsies are usually performed in a hospital ward or outpatient clinic, as a day procedure, so you would not need to stay overnight. You will be assessed before the biopsy, including your blood pressure and heart rate. There will be discussion regarding pain relief - the procedure will require some form of anaesthesia. 

Most people only require local anaesthetic, so you will be awake. This is injected using a small needle into the area where the biopsy will be performed, which will be numbed to reduce pain. You may experience a stinging sensation as the local anaesthetic is given, however this will go away very quickly. As well as the local anaesthetic, it may be possible to use gas and air during the procedure for further pain relief, if you want to – you can ask your doctors about this. 

In rare cases, a bone marrow biopsy may be performed under general anaesthetic, in which you will be asleep for the procedure. This is unusual in adults and is usually reserved for biopsies performed on children. 

Some adults may also require intravenous (IV) sedation, in which a sedative is given into a vein to help you to relax. You can ask your doctor for this if you are feeling very nervous. 

A needle will be used to take a small amount of liquid bone marrow. You may feel a sharp pain going down your leg, it should pass almost immediately, (if not, inform the person doing the procedure). This needle is then removed.  

After this, a different needle is inserted into the same site and is used to take a very small cylindrical sample of the solid bone marrow tissue. In most cases, it only takes a few minutes to remove the sample; you will feel some pressure as the needle goes into the bone, followed by a rocking motion and when it is taken out, it should contain a small core of bone marrow. 

After the needle is removed, pressure is applied to the area to stop bleeding and a dressing is put in place. You will be asked to lie on your back for 10-15 minutes following the procedure and apply pressure. You can expect the whole appointment to take around 30 minutes, including preparation and post-biopsy care. 

Afterwards, you can usually go straight home if you feel well enough to do so. If you have had IV sedation or a general anaesthetic, you will be taken to a recovery area until you are feeling well enough to go home.  You will usually be asked to rest at home for 24 hours. 

Once you are at home, wear the dressing and keep it dry for 24 hours. During this time, it is very important that you do not shower, bathe or swim. To make yourself more comfortable and reduce the risk of bleeding, avoid strenuous activity or exercise for a couple of days. 

You may notice some bruising after the procedure and ache for a few days, this is very common and nothing to worry about. This can be eased with over-the-counter pain relief, such as paracetamol. 

Generally, you should avoid taking ibuprofen unless you have been told that you can take it. 

If the pain persists, or you notice bleeding from the place the biopsy was taken from that doesn’t stop when you apply direct pressure, contact your doctor. 

You should contact your Haematology team if you experience any of the following symptoms: 

• Persistent fever 

• Increasing redness at the biopsy site 

• Worsening pain 

• Bleeding 

Bone marrow biopsies are very safe and complications are rare. However, there are some risks, including: 

• Infection 

• Discomfort at the biopsy site following the procedure 

• Excessive bleeding due to low levels of platelets, which is common for people with aplastic anaemia 

After your biopsy, the sample will be sent to a laboratory for analysis, and can help your doctor to: