Introduction
The diagnosis of blood diseases, very often, requires examination of the bone marrow. This procedure is called a bone marrow biopsy. The results determine treatment and prognosis.Bone marrow aspiration and/or biopsy are tests ordered by your doctor to evaluate your bone marrow function. Bone marrow produces red blood cells, white blood cells, and platelets. This test allows the doctor to study these cells in the various stages of development to better plan your treatment.Picture of a normal marrow biopsy appears under microscopy. There are red cells, white cells and platelets in between the fat cells.

Procedure

• A bone marrow biopsy is an outpatient procedure performed under local anesthesia and sedation.
• Using a special disposable needle and syringe, the doctor will withdraw a small amount of marrow blood from the hip bone (or uncommonly the breast bone), along with a tiny core of bone marrow tissue.
• The procedure takes around twenty minutes to complete and involves minimal discomfort.
• The marrow specimen is specially processed and examined by various techniques.
• It is only after these tests are performed that an accurate diagnosis can be made.
• The most appropriate therapy can then be recommended taking into account the findings of the bone marrow biopsy, current symptoms, age and health history.

After the procedure

• After the effect of the local anesthetic has worn off, you may feel some discomfort at the site of the puncture; walking may lessen this discomfort.
• The wound needs to be kept dry for 24 hours.
• Keep the wound covered for 2–3 days to prevent irritation by clothing.
• If bleeding from the wound occurs at home, lie on a hard surface with a towel rolled up under the biopsy site for no less than 10 minutes.
• You may experience leg pain; this is uncommon and should resolve within 6–7 days.
• A bruise may be evident and the site may be uncomfortable.
• If the wound becomes painful and red, contact the doctor as this may be an indication of infection.
• Paracetamol may be taken for pain (no more than 2 every 4 hours or maximum of 8 in 24 hours).

Indications of Bone Marrow Biopsy

• Diagnosis and follow up assessment of acute and chronic leukemias.
• Unexplained anemia, leukopenia, and/or thrombocytopenia.
• Unexplained prolonged fever.

Contraindications of Bone Marrow Biopsy

• Uncooperative patient.
• Cellulitis, osteomyelitis, or radiation therapy involving the proposed site of needle entry.
• Thoracic aortic aneurysm if a sternal approach is used.
• Paget’s disease, involving the iliac bone, represents a high risk situation due to excessive bleeding at trephine biopsy site (but not necessarily a contraindication).