Bone marrow aspiration

Bone marrow aspiration may be done in your health care provider's office or in a hospital. The bone marrow is removed from your pelvic or breast bone. Sometimes, another bone is selected.

Marrow is removed in the following steps:

• If needed, you are given medicine to help you relax.
• Your provider cleans the skin and injects numbing medicine into the area and surface of the bone.
• A special needle is inserted into the bone. The needle has a tube attached to it, which creates suction. A small sample of bone marrow fluid flows into the tube.
• The needle is removed.
• Pressure and then a bandage are applied to the skin.

The bone marrow fluid is sent to a lab and examined under a microscope.

Tell your provider:

• If you are allergic to any medicines
• If you are pregnant
• If you have bleeding problems
• What medicines you are taking

You will feel a sting and slight burning sensation when the numbing medicine is applied. You may feel pressure as the needle is inserted into the bone, and a sharp and usually painful sucking sensation as the marrow is removed. This feeling lasts for only a few seconds.

Your provider may order this test if you have abnormal types or numbers of red or white blood cells or platelets on a complete blood count.

This test is used to diagnose:

• Anemia (some types)
• Infections
• Leukemia
• Other blood cancers and disorders

It may help determine whether cancers have spread or responded to treatment.

The bone marrow should contain the proper number and types of:

• Blood-forming cells
• Connective tissues
• Fat cells

Abnormal results may be due to cancers of the bone marrow, including:

• Acute lymphocytic leukemia (ALL)
• Acute myelogenous leukemia (AML)
• Chronic lymphocytic leukemia (CLL)
• Chronic myelogenous leukemia (CML)

Abnormal results may also be due to other causes, such as:

• Bone marrow doesn't make enough blood cells (aplastic anemia)
• Bacterial or fungal infections that have spread throughout the body
• Cancer of the lymph tissue (Hodgkin or non-Hodgkin lymphoma)
• A bleeding disorder called idiopathic thrombocytopenic purpura (ITP)
• Blood cancer called (multiple myeloma)
• Disorder in which the bone marrow is replaced by scar tissue (myelofibrosis)
• Disorder in which the bone marrow produces too many red blood cells (polycythemia) or platelets (thrombocytosis)
• Disorder in which not enough healthy blood cells are made (myelodysplastic syndrome; MDS)

There may be some bleeding at the puncture site. More serious risks, such as serious bleeding or infection, are very rare.

Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

Bates I, Burthem J. Bone marrow biopsy. In: Bain BJ, Bates I, Laffan MA, eds. Dacie and Lewis Practical Haematology. 12th ed. Philadelphia, PA: Elsevier; 2017:chap 7.

Choby BA. Bone marrow aspiration and biopsy. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 220.

Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 31.

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.