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Bone Marrow Aspiration & Biopsy
By: Hamidreza Sanatinia, MD

What You Need to Know

Bone marrow is where the components of blood are manufactured. This includes the red cells, white cells and platelets. Examination of the bone marrow is the most valuable test to evaluate blood disorders. Bone marrow aspiration and biopsy also is used to stage certain types of cancers such as lymphomas and has also been used to as a diagnostic tool for fevers of unknown origin.

How Is It Done

Anesthesia

This procedure can easily be done at bedside. General anesthesia is therefore not necessary. For most patients, I usually administer 0.5-1 mg of lorazepam (Ativan) either intravenously or intramuscularly 10 minutes prior to the procedure. However, I make sure that the patient has transport to and from the office due to the tranquilizing effects of lorazepam.

I then use 2% lidocaine to numb the area including the outside linings of the bone. If done properly, and depending on the patients weight and overall condition, the procedure could be minimally painful.

The pain associated with bone marrow aspirate and biopsy is generally over-rated! If the lining of the bone is numb, the only pain that most patients experience is when the aspirate is being obtained from the bone (due to the presence of pressure inside the bone), and during the time when lidocaine is being injected into the area!

Complications

Complications include bleeding, infection and chronic pain. Bone perforation and hemorrhage may also occur. Please note that these complications are extremely rare.

In patients who undergo sternal bone marrow aspiration, heart damage is a potential complication. Again, this is a rare but certainly a potential complication. By using the guard provided with the bone marrow aspiration needle (the guard avoids deep penetration), this complication could be prevented. Bone marrow biopsies are never be obtained from the sternum.

Contraindications

Absolute contraindications (or when the procedure would not be done): Hemophilia or related coagulation disorders and infection involving the biopsy area. Low platelet count is not a contraindication.

Patient Instructions After the Procedure

1. Check the site frequently, and report any bleeding,
2. Keep the area dry.
3. The dressing can be removed in 48 hours.
4. Take acetaminophen or motrin for pain control. If the pain is worse, call your physician.

Hamidreza Sanatinia, MD
Board certified in Hemotology and Oncology