Bone Marrow Biopsy



Test Description
Bone marrow is the soft, sponge-like material contained in the medullary canals of
the long bones and within the spaces between trabeculae of cancellous bone. The
primary function of the bone marrow is the production of erythrocytes, leukocytes,
and platelets. When abnormal types or numbers of cells are found in a complete blood
count or the health-care provider needs to evaluate whether there might be a systemic
disease present in the bone marrow, a bone marrow biopsy and/or aspiration is performed.
In this procedure, a sample of the bone marrow is removed via a needle
inserted through the cortex of the bone and into the bone marrow. An aspiration of liquid
bone marrow may also be performed. The preferred site for the bone marrow
biopsy/aspiration is the iliac crest, although the sternum is also occasionally used.
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THE EVIDENCE FOR PRACTICE

 Bone marrow biopsy should be performed on patients with an abnormal complete blood
count, general symptoms such as fever, night sweats, weight loss, fatigue, and appetite loss,
elevated alkaline phosphatase, or symptoms of bone pain.
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Normal Value
Red marrow contains connective tissue, fat cells, and hematopoietic cells. Yellow marrow
contains connective tissue and fat cells.
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Possible Meanings of Abnormal Values
Agranulocytosis
Amyloidosis
Cancer
Depressed hematopoiesis
Granuloma
Infection
Infectious mononucleosis
Iron deficiency anemia
Leukemia
Lymphoma
Multiple myeloma
Myelodysplastic syndrome
Myelofibrosis
Platelet dysfunction
Polycythemia vera
Sideroblastic anemia
Thalassemia
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Interventions/Implications

Pretest
• Explain to the patient the purpose of the test. Provide any written teaching materials
available on the subject. Note that discomfort during the test is due to the injection of the
local anesthetic and removal of the marrow sample. Pressure may be felt during insertion
of the biopsy needle.
• Obtain baseline data regarding coagulation, such as prothrombin time, partial thromboplastin
time, and platelet count.
• No fasting is required prior to the test.
• Obtain a signed informed consent.
• Administer a sedative prior to the procedure, if ordered.

Procedure

• The procedure is usually done at the bedside with the patient in the prone or lateral position.
• The skin overlying the proposed site of the aspiration is cleansed and draped. A local
anesthetic is administered to the area. A very small incision may be made.
• A large-bore needle is slowly advanced through the incision, subcutaneous tissue, and
the cortex of the bone. Once inside the marrow, the stylet is removed from the needle,
and a syringe is attached.
• A sample of 0.5 to 2 mL of liquid bone marrow is aspirated and slide preparation is
completed.
• The biopsy needle is then advanced and rotated in both directions, forcing a sample of
the bone marrow into the needle.
• The needle is then withdrawn, with pressure applied to the site for 10 to 15 minutes. The
sample is forced out of the needle and into a specimen jar containing fixative.
• A sterile dressing is applied to the biopsy site.
• Gloves are worn throughout the procedure.

Posttest
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• Observe the puncture site for bleeding.
• Assess for signs of infection: tenderness and erythema at the site, fever.
• Assess for signs of hemorrhage: increased pulse rate, decreased blood pressure, pain.
• Ideally, the patient should maintain bedrest for at least 1 hour. However, this procedure
  is now often done in clinic settings where this is not practical.
• Label the specimen and transport it to the laboratory immediately.
• Report abnormal findings to the primary care provider.
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Clinical alert                      
• Possible complications include: Hemorrhage from the puncture site and infection
at the site.
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Contraindication !           

• Patients with bleeding disorders
• Patients unable to cooperate with the examination
  

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