Bone Marrow, after the blood itself is the largest and most widely
distributed organ in the body, where blood is produced. Our bone
marrow contains about 1 trillion cells and releases approximately 200
billion red cells, 100 billion white cells and 400 billion platelets each
Bone marrow aspiration and biopsy are now well-accepted procedures for
evaluation both the cellularity of the marrow and the nature of the cells
present. Although sternum (breast bone) is the traditional site for bone
marrow aspiration (but not for biopsy), our preferred site is the posterior
Iliac crest (the hip bone) because of ease and safety and the fact that the
posterior Iliac crest is usually quite cellular.
Unexplained anemia. Decreased presence of red blood cells, the
cause of which may be a variety of reasons, the most common being deficiency of
iron stores and Myelodysplasia.
Thrombocytopenia. Decreased production of platelets, I.T.P. (or
Idiopathic Thrombocytopenia) being most common. Physicians determine if
adequate number of platelet producing cells (Megakaryocytes) are present in the
- Pancytopenia. Decreased production of all three cell lines,
differentiates relative involvement of red cell, white cell and platelet
lines in a disease.
(helpful in diagnoses,
staging and determining results of the treatment)
- Lympho and Myeloproliferative disorders.
disease. To determine if bone
marrow is involved with cancers from other sites.
- Chromosomal analyses
- Unusual infection. Such as Tuberculoses,
Fungi and Fevers of Unknown Origin
- Hemophilia and other Clotting disorders. (If you are
taking a blood thinner your doctor needs to be informed before the
- Previous Radiation Therapy site.
PRE- and POST-PROCEDURE PATIENT EDUCATION:
Procedure is performed under local anesthesia, therefore patient can eat or
drink any time before or after the procedure. The patient will need to
remain in a supine position (lay on the back) for about an hour after the
procedure to help keep pressure on the biopsy site. The urinary bladder
should be emptied before the procedure. The bandage over the biopsy site
may be removed 24 hours after the procedure. Ask the patient to notify
the physician of any pain, drainage, fever or spreading redness around the
biopsy site area. A standard consent form should be signed by all
patients before the procedure.
Questions & Answers
Q. Why is a bone marrow
biopsy being performed?
Normal white blood cell (WBC are between
4.5-10x10  UL.)
Normal hemoglobin (HBG is between 12-16 gm/dl.)
Normal platelets (usually between 120 to 500x10 UL)
To determine if any of the above are high or low is one of the
most common reasons to
perform a bone marrow biopsy.
Additionally primary cancers of the bone marrow such as leukemia,
myeloma and lymphoma or check for cancers involving from other sites such as metastatic
disease may be another common reason to perform this test.
Q. Does it hurt?
A. Yes, but only momentarily. It depends upon
the technique being used by the physician to perform the test. (see the
video) The trick is to numb up the area well and perform the aspirate and
the biopsy in the shortest amount of time possible. If your pain threshold
is low, you may need to ask your physician to give you some pain medication
Q. What sort of things can
A. Very rarely are there any
complications. Hemorrhage and infection can be prevented by applying
pressure and performing the procedure in a sterile fashion.
Q. What can I do to make
things go smoothly?
A. The most important thing for you to do is to lay
very still. Ask your physician to let you know when he is going to
aspirate the marrow (watch the video). At that moment you may experience slight
discomfort or momentary pain that may only last a couple of seconds. The
best thing to do is to hold your breath for those few seconds or to count
backwards from 20 to 1 while the biopsy is being obtained.