What is Bone Marrow Biopsy?

Overview

A biopsy is a medical term for a procedure that involves the removal of a small sample of tissue, cells, or fluids from the body to examine it to help establish the diagnosis of different diseases, such as cancers, or infections. However, even after the identification of a condition, a biopsy can still be performed to determine the severity of that condition.

Biopsies can be performed on various parts of the body including the skin, organs, or other tissues, depending on the medical issue suspected.¹

After removal from the body, the collected sample is examined under a microscope or put through additional laboratory tests to obtain important information for diagnosis.

What is a bone marrow biopsy?

A bone marrow biopsy is a type of biopsy in which a small sample of the patient's bone marrow is taken out for analysis. There are two types of bone marrow – the liquid tissue and the solid tissue portions.

A thick, hollow needle, is used to sample the solid bone marrow in the procedure called a bone marrow biopsy or core biopsy. The liquid portion is sampled using a thinner, hollow needle, in a process called aspiration. The liquid portion contains blood stem cells, blood cells in various stages of development from the stem cells, and things such as iron, vitamin B12, and folate that are necessary for cell production. Usually, both procedures are carried out at the same appointment.

Red bone marrow is primarily found in bones like the hip and vertebrae and contains blood stem cells that are capable of going on to become red and white blood cells, or blood platelets. Red marrow is usually sampled from the back of the hip bone by your doctor, a needle is typically used to remove a sample of the solid part of the bone marrow during a bone biopsy. The sample is used to identify and monitor blood and marrow disorders, such as certain cancers, as well as fevers with unidentified causes.² 

Yellow marrow contains stem cells that are able to develop into cartilage, fat, or bone cells. But it is mostly comprised of fat - bone marrow becomes more yellow with age as the fat cells grow. During emergencies, the body transforms yellow bone marrow into red to help us stay alive.

Common sites for bone marrow biopsy

The bone marrow biopsy can be performed at two main sites:

• The pelvic (hip) bone
• The sternum (breastbone)

The sample for bone marrow biopsy is usually taken out from the back of the pelvic (or hip) bone, just below the waist. However, occasionally the bone marrow biopsy can be performed on the breastbone (sternum).³ The age of the patient, the purpose of the biopsy, and the doctor's preference all play a role in deciding the site for the biopsy.

Overview of the bone biopsy procedure

Usually, a doctor who is an expert in blood disorders or cancer such as a haematologist or an oncologist, will perform the procedure. A biopsy can be carried out at a doctor's office, a clinic, or a hospital, and the procedure itself takes 10 to 20 minutes in total:

• Before the biopsy, your blood pressure and heart rate will be checked and you will change into a hospital gown. Your doctor will ask you to lie on your stomach, or your side 
• Local anaesthetic will be used to numb the skin and bone in the region where the biopsy will take place. Your doctor might do a bone marrow aspiration first before the biopsy. This involves taking a sample of the liquid portion of the bone marrow⁴
• The top ridge of the back of a pelvis (posterior iliac crest) or the breastbone are the most typical sites for a bone marrow biopsy
• The anaesthetic injection may cause a brief sting. After that, your doctor will make a tiny skin incision so that a hollow needle can enter your body
• While collecting red marrow, the needle, fortunately, enters the bone well away from your spinal cord, so is extremely unlikely to cause nerve-type sharp pain. However, you may experience a dull ache or discomfort as the needle penetrates the bone
• Following the procedure, your doctor will apply pressure to the area to prevent any bleeding before bandaging the incision. After about fifteen minutes, the effects of the local anaesthesia will have worn off allowing you to leave your doctor's office
• After your bone marrow examination, you might experience discomfort for up to a week. Consult your doctor before using any painkillers, such as paracetamol (acetaminophen) or NSAIDs^3,5

The purpose and goals of bone marrow biopsy

A bone marrow biopsy may be performed for several reasons, such as determining the cause of a low or high level of:

• Red blood cells (RBCs)
• White blood cells
• Platelets, or blood-clotting cells

This can help diagnose different types of cancers, or a wide range of distinct medical conditions that may cause these blood abnormalities.⁶

Indications for bone marrow biopsy

The presence of abnormal types or numbers of red or white blood cells or platelets revealed in a complete blood count (CBC) are indications for a bone biopsy.

The test is instrumental in indicating:

• Certain types of anaemia
• Infections
• Leukaemia
• Various other blood-related cancers and disorders

Additionally, It can help determine how the cancer is responding to treatment and whether the cancer has spread.⁷

Preparation and precautions

Before the biopsy, inform your doctor about:

• Any allergies to medication you may have
• The medications you are currently using
• Any issues related to bleeding
• If you are currently pregnant
• If you have anxiety or other stress-related issues¹⁰

Potential risks and side effects

According to the Cancer Research UK, bone marrow exams are usually safe. However, some complications that can occur include:

• Bleeding – is a concern, especially for those taking blood thinners and people with a low platelet count (thrombocytopenia). Therefore, it's important to let your doctor know if you're taking any blood thinners, such as aspirin, warfarin, rivaroxaban etc. This information helps the doctor and you make informed decisions about the safety and management of procedures like bone marrow biopsy
• Infection can occur, mostly in the skin at the exam site, especially if the immune system is weak
• Long-lasting discomfort at the examination site
• Very rarely, the needle may pierce through the breastbone during sternal aspirations, which can cause heart or lung problems⁸

Pain management during biopsy

Examining the bone marrow is important for identifying and managing diseases. But, for patients, it's potentially a painful or uncomfortable experience. Most places use a local anaesthetic such as lidocaine to numb the area. Some studies show that combining different drugs or methods with local anaesthesia can help more. Sedation, using drugs such as benzodiazepines, helps with anxiety and pain. Giving patients clear information is crucial to make them more comfortable. Distraction techniques, like music therapy, can also help reduce pain.⁹

Analysis of biopsy results

A doctor called a pathologist will look at your bone marrow sample using a microscope. Then, your regular doctor will check what the pathologist found and tell you what comes next. They might confirm what's wrong, ask for more tests, or suggest changes to your treatment based on the results.

Conditions diagnosed through bone marrow biopsy

Bone marrow biopsy helps find cancers that affect your blood and bone marrow. It can also diagnose conditions like anaemia. It can also help in diagnosing abnormalities in blood cells or various blood cancers, including leukaemia and lymphoma.

Furthermore, it can find secondary cancers that have spread to the bone marrow from other parts of the body, including breast cancer or lung cancer. The test also detects problems like myelofibrosis (a rare blood cancer) and myelodysplastic syndrome, where the bone marrow struggles to make cells properly. It's a helpful tool to understand and deal with different health issues related to the blood and bone marrow.

FAQ's

Is a bone marrow biopsy a painful procedure? 

Yes, a bone marrow biopsy can potentially be a painful procedure, but anaesthesia or sedation is usually used to help manage the pain.

How long does a bone marrow biopsy take? 

The duration of a bone marrow biopsy is relatively short, typically taking about 10 to 20 minutes.

How soon can normal activities be resumed after the biopsy? 

Normal activities can usually be resumed shortly after the biopsy, although individual recovery times may vary.

Can children undergo bone marrow biopsies? 

Yes, children can undergo bone marrow biopsies, and the procedure is adapted to suit their specific needs and comfort.

What information is obtained from a bone marrow biopsy that other tests may not provide? 

A bone marrow biopsy provides detailed information about the structure, cells, and health of the bone marrow, offering insights that may not be obtainable through other tests.

How frequently are follow-up bone marrow biopsies required to monitor certain conditions? 

The frequency of follow-up bone marrow biopsies depends on the specific medical condition being monitored, and the decision is made by healthcare professionals based on individual patient needs and circumstances.

Summary

A bone marrow biopsy is a medical test that helps doctors understand the health of the bone marrow which is responsible for making blood cells. The biopsy provides important information about the structure and condition of the bone marrow, helping diagnose various blood disorders and cancers. The test is relatively short, taking about 10 to 20 minutes, and normal activities can usually be resumed soon afterwards.