What is a bone marrow aspirate or bone marrow biopsy?
The bone marrow is soft, sponge-like tissue inside the bones that produces white blood cells, red blood cells, and platelets. Bone marrow aspirations or biopsies are tests that take a sample of the bone marrow. An aspiration removes a small sample of blood-like fluid. A biopsy breaks off a small piece of the bone marrow tissue.

What information will it give my doctors?
A bone marrow aspirate or biopsy will provide information about the cells in your bone marrow. It will show if there are cancer cells in the bone marrow. It will also show if normal cells are beginning to regrow after treatment.

What should my health care professional know before I have this test/procedure done?

• Tell your doctor or nurse if you have an allergy to Betadine®, iodine, or shellfish
• Tell your doctor or nurse if you have an allergy to local anesthetics

Where is this done?
The bone marrow aspirate or biopsy may be done in your hospital room or clinic examination room or procedure room. Sometimes, inpatients are transported to Duke Clinic to have the procedure in the clinic procedure room.

Do I need to have someone drive me home afterward?
It is recommended that you have someone available to drive you home if you are having this procedure as an outpatient. If you have a long drive, or drive a standard transmission vehicle, you may experience discomfort in your hip that could be distracting while you drive. If you have a short drive or have had the procedure before, you may feel comfortable driving yourself home after this procedure. If you take medicine in addition to the numbing medicine (local anesthetic) to control pain or help you relax, you will need someone to drive you home.

Do I need to do anything to get ready for this test?
The bone marrow tests do not require any special preparation. You will not need to disrobe completely but wear loose clothing that you can easily move to expose the hipbone area.

What happens during the procedure? Is this test/procedure painful?
Most bone marrow tests are done in the back of the hipbone (posterior iliac crest). Occasionally, bone marrow tests are done in the front of the hipbone (anterior iliac crest) or in the breastbone (sternum).

• You will be asked to lie on your stomach or side if the test is done in the back of the hipbone and on your back if it is done in the breastbone or front of the hipbone.
• The skin over the area will be cleaned with Betadine®.
• A numbing medicine (local anesthetic) will be injected into the area. You may feel a burning or stinging feeling during this injection. This should go away in a few seconds. Many patients feel this is the worst part of the procedure.
• After the area is numb, a special needle is inserted to remove the sample. You will feel pressure while the needle is being inserted. As the needle is inserted into the marrow space, you may feel increased pressure or pain. As the aspiration sample is taken, you may feel a sharp pain or pulling sensation, but this should last only a second or two. If a biopsy is taken, you may feel a dull ache similar to a toothache. This usually lasts only 30 seconds to a minute.
• The doctor, nurse, or physician assistant performing the procedure will tell you as they begin each new step so you can prepare yourself. Deep breathing or other relaxation techniques can be helpful during the procedure. If you know that you are very sensitive to pain, let the doctor know in advance so extra pain medicine can be considered. Our goal is for you to have a procedure that you can tolerate, with the minimum of side effects from anesthetics or other medications.

How long does it take?
The entire procedure, including the skin cleaning before, usually takes less than 15 minutes.

What happens after the procedure?

• After a bone marrow test, pressure will be applied to the site to stop any bleeding. Then, a small gauze dressing is applied. Keep this dressing on for 24 to 48 hours.
• You may feel soreness at the site for two to three days after the anesthetic has worn off. Check with your doctor or nurse about what medicines you can take to relieve the discomfort.

What are the risks with this procedure?
As with any procedure, there are small risks of bleeding and infection. These may be increased at times when you are more susceptible to bleeding or infection due to your disease or treatment. Precautions are taken to protect you from those risks as much as possible.

How will I get the results of this test?
Your doctor will contact you with the results of the test. How long this will take depends on the information the doctor is looking for from the bone marrow test, as well as the type of test. Biopsy results may take longer than results of bone marrow aspiration.

Call your doctor if any of these things happen to you.
Call your doctor or nurse if you notice:

• bleeding -- apply pressure and contact your doctor or nurse right away
• increased bruising after the first day
• swelling
• signs of infection such as fever, redness, drainage from the site or increased tenderness

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.

Source: Duke Cancer Patient Education Program; approved: Duke PEC, 12/03