The bone marrow biopsy and aspiration provide information about the status of and capability for blood cell production. They are not routinely ordered and in fact the majority of people will never have one done. A marrow aspiration and/or biopsy may be ordered to help evaluate blood cell production, to help diagnose leukemia, to help diagnose a bone marrow disorder, to help diagnose and stage a variety of other types of cancer (to determine spread into the marrow), and to help determine whether a severe anemia is due to decreased RBC production, increased loss, abnormal RBC production, and/or to a vitamin or mineral deficiency or excess. Conditions that affect the marrow can affect the number, mixture, and maturity of the cells, and can affect its fibrous structure.

A bone marrow sample may also be evaluated and cultured for the presence of microorganisms such as fungi, bacteria, or mycobacteria (such as that which causes tuberculosis) when the patient has a fever of unknown origin. Additional marrow testing may be ordered when it is suspected that the patient has a chromosomal abnormality and/or a disorder associated with iron storage that may cause iron to accumulate in the marrow.

When a person is being treated for a cancer, a bone marrow aspiration and/or biopsy may be ordered to evaluate the response to therapy to determine whether suppressed marrow function is beginning to return to normal.

A CBC and reticulocyte count are frequently ordered along with the bone marrow aspiration/biopsy. The results are used to help evaluate cell production in the marrow and compare it to current cell populations in circulation.

A bone marrow aspiration and/or biopsy may be indicated as follows:

As a diagnostic procedure when one of the following is suspected:

• Aplastic Anemia
• Acute Leukemia
• Myelodysplastic Syndrome
• Chronic Myelogenous Leukemia
• Myelofibrosis and Essential Thrombocythemia
• Multiple Myeloma
• Severe thrombocytopenia and/or anemia and/or neutropenia

As a staging procedure in:

• Hodgin’s and Non-Hodgkins lymphomas
• Small Cell Carcinoma of the Lung (although this not frequently done anymore)

For culturing:

• when fever is present in HIV/AIDS or other immuno-compromised patient
• in patients suspected of having Brucellosis or Typhoid Fever

A bone marrow biopsy and aspiration may also be ordered at intervals when a person is being treated for a cancer to evaluate whether marrow function is being suppressed and if it is, when its function begins to recover.

With a bone marrow biopsy and aspiration the doctor is evaluating what is in the marrow in order to determine whether the cells found are normal and present in typical quantities, to determine whether there are cells present that shouldn’t be there (such as abnormal cells that are characteristic of specific cancers or disorders such as the Gaucher cell found with Gaucher’s disease or the foamy lipid-filled Niemann-Pick cell found with Niemann-Pick disease), and to determine what is missing.

The training and expertise of the pathologist or hematologist evaluating the marrow samples allows him to sort through the marrow clues and tell the doctor what is happening in the marrow. In most cases, this information can confirm or rule out a diagnosis and bone marrow involvement, but it can also point out the need for further investigation. For instance, if there are a decreased number of RBCs in the blood and an increased number of reticulocytes, and a marrow evaluation shows that RBC production appears normal but increased, then the doctor knows that marrow production of RBCs has increased appropriately to meet a RBC demand. What she still doesn’t know is the reason for the demand. It could be due to an acute or chronic loss of RBCs (such as may occur with gastrointestinal bleeding) or due to acute or chronic RBC destruction (such as sometimes occurs with an artificial heart valve).

A patient with few RBCs and no increase in reticulocytes may have aplastic anemia (suppressed RBC production in the marrow). An evaluation of the bone marrow may confirm this condition but it does not necessarily tell the doctor whether it is due to a bone marrow disorder, radiation, exposure to certain chemicals, some cancers, cancer treatment, or due to a tuberculosis infection.

The doctor takes the information that she receives from the marrow evaluation and combines it with information from a clinical examination, blood tests, and a variety of other tests, such as imaging scans and X-rays, to reach a final diagnosis. It can be a straightforward process or it can be a complex diagnostic puzzle. Patients should stay involved in this process by talking to their doctor before and after a bone marrow biopsy and/or aspiration, asking her what her suspicions are, what kind of information she is hoping to obtain from the evaluation, and what follow-up tests might be indicated.

Complications from the bone marrow aspiration and/or biopsy procedure are rare, but some patients may have excessive bleeding at the collection site or develop an infection. Patients should tell the doctor about any allergies they have, and about any medications or supplements they are taking prior to the procedure and should contact their doctor promptly if they experience persistent or spreading redness or bleeding at the site, a fever, or increasing pain.