What is a Bone Marrow Biopsy?

In medicine, a bone marrow biopsy is a procedure involving the removal of a bone marrow sample from a patient, to be used in evaluating the health and function of the bone marrow. There are two major kinds of bone marrow biopsies, a bone marrow trephine biopsy and a bone marrow aspiration. Both kinds of bone marrow tests are usually, but not always, performed on the patient’s hipbone.

In a bone marrow aspiration procedure, a doctor typically inserts a bone marrow needle into the patient’s hipbone and extracts some bone marrow cells by means of suction applied with a syringe. Sometimes an aspiration procedure is performed on the sternum, which is the main bone of the chest. Patients usually report a sharp pain when the suction is performed.

A bone marrow trephine biopsy differs from an aspiration in the nature of the sample it yields. A trephine biopsy typically produces a sample of bone marrow cells along with a tiny piece of bone. A thicker needle is usually needed for a trephine procedure than is used in an aspiration procedure.

Instead of a simple suction action, a trephine procedure involves moving the needles back and forth within the bone, in order to obtain a core sample in one piece. The movement of the needle within the patient’s bone may cause significant discomfort. Trephine biopsies are usually performed on the hipbone, and the sternum should not be used as a site for this type of biopsy, as there would be a risk of damaging the lungs or the heart.

Some of the conditions that may be diagnosed with the help of a bone marrow biopsy include bone marrow infection, certain types of anemia, and various cancers. Cancers that can be diagnosed using bone marrow biopsy procedures include leukemia, Hodgkin's and non-Hodgkin's lymphomas, and advanced breast cancer that has spread to the sternum. In addition to the diagnosis of cancer, bone marrow biopsies may be performed on cancer patients in order to help assess the spread and progression of the disease, and to help doctors to determine how well a patient is responding to treatment.

A bone marrow biopsy may also be used to identify certain rare blood disorders such as myelodysplastic syndrome, neutropenia, and thrombocytopaenia. Myelodysplastic syndrome is a condition where the bone marrow function is impaired, and insufficient red blood cells are being produced. Neutropenia is identified by a low white blood cell count. Thrombocytopaenia is a disorder where the bone marrow is not producing sufficient platelets, resulting in an impaired clotting process. In all of these types of diseases, a bone marrow biopsy can allow doctors to analyze the function of the bone marrow.