17735 Bone Marrow Biopsy

Overview

A bone marrow biopsy is a test that takes a small sample of bone marrow. Bone marrow is the soft, spongy tissue inside some bones where blood cells are made. The sample helps doctors see how your bone marrow is working and look for blood disorders, cancers, or other problems. It is not a treatment, and needing one does not mean you have cancer.

A bone marrow biopsy is a common specialised test in blood and cancer care, but it is not a routine test for most people. Doctors arrange it only when the information is likely to be helpful.

It can be done at any age, from children to older adults. It is more often used for adults with blood problems or certain cancers, and sometimes for children with serious blood or immune conditions. A specialist doctor decides if it is needed.

Symptoms

Common symptoms

• A bone marrow biopsy is a test, not a disease, so it does not have symptoms of its own. Doctors may arrange one because of:
• Unexplained low or high blood counts on a blood test
• Feeling very tired, weak, or short of breath from low red blood cells
• Frequent infections or fevers with no clear cause
• Easy bruising or bleeding
• Unexplained weight loss, night sweats, or bone pain
• Swollen lymph nodes or an enlarged spleen
• A need to check whether a blood cancer has spread or how treatment is working
• A need to monitor a known blood or bone marrow condition

Symptoms in children

• Children may need a bone marrow biopsy for severe low blood counts, a type of blood cancer such as leukaemia, or certain immune problems.
• The children's team will explain the test in words your child can understand.
• Children are often given medicine to help them relax or sleep during the procedure.
• A parent or caregiver can usually stay nearby if the hospital allows it.

Symptoms in older adults

• Blood disorders and some cancers are more common with age, so a biopsy may be more likely.
• Older adults may take blood-thinning medicines or have other health conditions, so the care team will check these first.
• The team will also plan extra support if you need help getting home or managing everyday tasks after the test.

Causes

Main causes

• A bone marrow biopsy is done to find the cause of abnormal blood tests, such as low red blood cells, low white blood cells, or low platelets.
• It can help diagnose or rule out blood cancers, including leukaemia, lymphoma, and multiple myeloma.
• It can check whether a cancer has spread to the bone marrow.
• It can help find the cause of a fever or infection that is not clear.
• It can show how well treatment is working or whether a condition has come back.
• It can help plan a bone marrow transplant.
• It can help diagnose rare bone marrow diseases or immune problems.

Risk factors

• Having a known blood disorder or blood cancer.
• Having abnormal blood test results with no clear cause.
• Being treated with chemotherapy or radiation, or having had these treatments in the past.
• Having a condition that affects the immune system.
• Being older, because some blood problems are more common with age.
• Taking blood-thinning medicines or having a bleeding disorder, which can affect planning for the test.

When to see a doctor

See a doctor urgently if:

• After the biopsy, contact your care team the same day if you have a fever.
• Contact your care team the same day if the site becomes red, warm, swollen, or leaks pus.
• Contact your care team the same day if bleeding or oozing continues.
• Contact your care team the same day if pain is getting worse or is hard to manage.
• Contact your care team the same day if you feel dizzy or faint.

Book a routine appointment if:

• Before the biopsy, ask your care team any questions about why it is needed, what will happen, and how to prepare.
• Tell your care team about all medicines, supplements, allergies, bleeding problems, and pregnancy.
• After the biopsy, keep your results appointment even if you feel well.
• Ask your care team when you can shower, bathe, or return to exercise.
• Speak to your doctor if you feel very anxious or need more support while waiting for results.

Diagnosis

A bone marrow biopsy is itself a diagnostic test. Your doctor will first ask about your health, examine you, and review blood tests or scans. During the biopsy, a small sample of bone marrow is removed. A pathologist, a doctor who studies cells under a microscope, examines the sample and may order special tests.

Tests that may be done

• Full blood count, which counts your red cells, white cells, and platelets.
• Blood film, where a drop of blood is looked at under a microscope.
• Imaging scans if your doctor needs to see your bones, organs, or lymph nodes.
• Bone marrow aspirate, a liquid sample often taken at the same time as the biopsy.
• Flow cytometry, a lab test that checks markers on cells.
• Genetic or molecular tests on the bone marrow sample.
• Tests to look for infection if you have an unexplained fever.

What to expect at your appointment

You may be asked to lie on your side or your stomach. The skin over the hip bone is cleaned and numbed with a small injection. You may feel a brief sharp feeling when the numbing medicine goes in, and pressure when the samples are taken. A small needle takes liquid marrow, and a slightly larger needle takes a tiny core of bone marrow. A dressing is put on the site. If you are given medicine to help you relax, you may need someone to drive you home. Rest for the day and follow your care team's instructions.

Treatment

A bone marrow biopsy is not a treatment. It gives your doctor information. What happens next depends on what the sample shows. Some people need no treatment, some need monitoring, and some need care for a blood or bone marrow condition.

Self-care at home

• Follow the written instructions from your care team.
• Keep the dressing clean and dry for as long as your care team advises.
• Avoid heavy lifting, vigorous exercise, or straining for about 24 to 48 hours, or as advised.
• Use simple pain relief only as recommended by your care team.
• Check the site each day for redness, swelling, bleeding, or pus.
• Drink normal amounts of fluid and eat as usual unless told otherwise.
• Ask when you can shower or bathe and when you can return to work or school.

Medical treatments

If the biopsy shows a condition, your care team will explain the options. These may include monitoring, medicines, blood transfusions, or other therapies. They will discuss the benefits and risks with you. No treatment is started based only on this article.

When is surgery considered?

A bone marrow biopsy is a short procedure, not usually called surgery. If your care plan includes surgery for another reason, your team will explain it separately.

Living with this condition

Most people feel back to normal within one or two days. The site may be tender or bruised for a short time. Waiting for results can be stressful, so it can help to plan distracting activities and write down questions for your care team.

Lifestyle tips

• Keep the biopsy site clean and dry until your care team says otherwise.
• Return to gentle activity first, then build up as you feel able.
• Avoid pressing or rubbing the site.
• Notice how you feel and report any fever, bleeding, or increasing pain.
• Keep all follow-up appointments and blood tests.
• Ask a family member or friend to come with you if you feel anxious or need help getting home.

Diet and exercise

Eat a normal balanced diet and drink enough fluid. Gentle walking is usually fine after the procedure. Avoid heavy exercise, swimming, or straining until your care team says it is safe. If you have another health condition, follow the diet and exercise advice your doctor has already given you.

Mental health and emotional wellbeing

It is common to feel worried before a bone marrow biopsy or while waiting for results. Talk to your care team about your fears. If anxiety is affecting your sleep, appetite, or daily life, ask for support. If you feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a local crisis service right away.

Prevention

You cannot prevent needing a bone marrow biopsy in many cases, because it is a test used to find answers. You can lower the risk of problems by telling your care team about allergies, bleeding problems, pregnancy, and all medicines and supplements, and by following their instructions.

Vaccines

No vaccine prevents the need for a bone marrow biopsy. Keep your vaccinations up to date as advised by your healthcare provider, especially if you have a blood condition or a weakened immune system.

Screening programmes

There is no screening test that tells you whether you need a bone marrow biopsy. If you have a known blood or bone marrow condition, keep your monitoring appointments and blood tests.

Complications

If left untreated

• If the biopsy is not done, your doctor may not have enough information to diagnose or monitor your condition.
• This could delay treatment or make it harder to plan the right care.
• An underlying blood or bone marrow problem may get worse if it is not found and managed.
• You may be left with uncertainty about whether treatment is needed.

Long-term outlook

Most people recover from a bone marrow biopsy within a few days. The results can be an important step in getting the right care. Many blood and bone marrow problems can be managed or treated, and your care team will support you through the next steps.

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