Bone Marrow Aspiration and Biopsy

The bone marrow biopsy and aspiration procedure provides information about the status of and capability for blood cell production. It is not routinely used and in fact the majority of people will never have one done. A bone marrow aspiration and/or biopsy may be requested to help measure blood cell production, to help diagnose leukaemia, to help diagnose a bone marrow disease, to help diagnose and find out whether a variety of other types of cancer have spread into the marrow, and to help discover whether a severe anaemia 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 used when it is suspected that the patient has a chromosomal abnormality and/or a disease which has brought an increase in iron storage in the marrow.

When a person is being treated for a cancer, a bone marrow aspiration and/or biopsy may be requested to find out the response to therapy and whether suppressed marrow function is beginning to return to normal, or use special tests to look for tiny amounts leukaemia

A FBC and reticulocyte count are frequently used with bone marrow aspiration/biopsy. The results are used to help measure cell production in the marrow and compare it to current cell populations in the blood.

A bone marrow aspiration and/or biopsy may be used as a diagnostic procedure when, for example, one of the following is suspected:

• Aplastic Anaemia
• Acute Leukaemia
• Myelodysplastic Syndrome
• Chronic Myeloid Leukaemia
• Myelofibrosis and Essential Thrombocythaemia
• Multiple Myeloma
• Severe thrombocytopenia and/or anaemia and/or neutropenia

It may be used for ‘staging’ certain cancers. ‘Staging’ is a careful and thorough examination which helps the doctor record how far the cancer has spread and what body organs are also affected. These may include:

• Hodgkin and Non-Hodgkin lymphomas
• Small Cell Carcinoma of the Lung (not frequently done anymore)

It may be used to look for infection in some cases, such as:

• When fever is present in HIV/AIDS or other immuno-compromised patients
• In patients suspected of having infectious diseases such as Brucellosis or Typhoid Fever

A bone marrow biopsy and aspiration may also be used at intervals when a person is being treated for a cancer to find out 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 looking at what is in the marrow in order to find out whether the cells found are normal and present in normal quantities, to find out whether there are cells present that should not be there, and to look at what is missing.

The training and experience of the pathologists or haematologists evaluating the marrow samples allows them to sort through the marrow clues and find out 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 patient’s doctor knows that marrow production of RBCs has increased appropriately to meet a RBC demand. What they still don’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 anaemia with 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, cancer, cancer treatment, or due to a tuberculosis infection.

The presence of some abnormal cells can be 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.

There may be masses of cells forming tumours in the marrow, such as can occur with multiple myeloma, or changes to or increases in the fibrous network that supports cellular production.

Doctors take the information they receive from the marrow evaluation and combine 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 what their suspicions are, what kind of information they hope to obtain from the evaluation, and what follow-up tests might be indicated.

Complications from the bone marrow aspiration and/or biopsy procedure are very 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 drugs or supplements they are taking before 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.