A bone marrow aspiration and biopsy can be done in a hospital, clinic or doctor's office.
The procedures are usually done by a doctor who specializes in blood disorders (hematologist) or cancer (oncologist). But bone marrow exams may also be performed by nurses with special training.
The bone marrow exam typically takes about 10 to 20 minutes. Extra time is needed for preparation and post-procedure care, especially if you receive intravenous (IV) sedation.
Before the procedure
Your blood pressure and heart rate will be checked, and you'll be given some form of anesthesia to keep you comfortable.
A bone marrow examination can be done with only local anesthesia to numb the area where the needles will be inserted. With local anesthesia, bone marrow aspiration, in particular, can cause brief, but sharp, pain. Many people choose to also have light sedation for additional pain relief.
If you're anxious about pain, you may be given an IV medication so that you're either completely or partially sedated during the bone marrow exam.
The area where the biopsy needles will be inserted is marked and cleaned with an antiseptic. The bone marrow fluid (aspirate) and tissue sample (biopsy) are usually collected from the top ridge of the back of a hipbone (posterior iliac crest). Sometimes, the front of the hip may be used.
You'll be asked to lie on your abdomen or side, and your body will be draped with cloth so that only the exam site is showing.
Rarely, bone marrow aspiration — but not biopsy — is collected from the breastbone or, in children under the age of 12 to 18 months, from the lower leg bone.
Bone marrow aspiration
The bone marrow aspiration is usually done first. The doctor or nurse makes a small incision in the skin, then inserts a hollow needle through the bone and into the bone marrow.
Using a syringe attached to the needle, a sample of the liquid portion of the bone marrow is withdrawn. You may feel a brief sharp pain or stinging. The aspiration takes only a few minutes. Several samples may be taken.
The health care team checks the sample to make sure it's adequate. Rarely, fluid can't be withdrawn and the needle is moved for another attempt.
Bone marrow biopsy
The doctor or nurse uses a larger needle to withdraw a sample of solid bone marrow tissue. The biopsy needle is specially designed to collect a core (cylindrical sample) of bone marrow.
After the procedure
Pressure will be applied to the area where the needle was inserted to stop the bleeding. Then a bandage will be placed on the site.
If you had local anesthesia, you'll be asked to lie on your back for 10 to 15 minutes and apply pressure to the biopsy site. You can then leave and go about your day, returning to normal activity as soon as you feel up to it.
If you had IV sedation, you'll be taken to a recovery area. Plan to have someone drive you home, and take it easy for 24 hours.
You may feel some tenderness for a week or more after your bone marrow exam. Ask your doctor about taking a pain reliever, such as acetaminophen (Tylenol, others).
Site care
Wear the bandage and keep it dry for 24 hours. Don't shower, bathe, swim or use a hot tub. After 24 hours you can get the area wet.
Contact your doctor if you have:
- Bleeding that soaks through the bandage or doesn't stop with direct pressure
- A persistent fever
- Worsening pain or discomfort
- Swelling at the procedure site
- Increasing redness or drainage at the procedure site
To help minimize bleeding and discomfort, avoid rigorous activity or exercise for a day or two.