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What Are Bone Marrow Tests?

Bone marrow tests check whether your bone marrow is healthy. These tests also show whether your bone marrow is making normal amounts of blood cells.

Bone marrow is a sponge-like tissue inside the bones. It contains stem cells that develop into the three types of blood cells that the body needs:

  • Red blood cells carry oxygen throughout your body.
  • White blood cells fight infections.
  • Platelets (PLATE-lets) stop bleeding.

Another type of stem cell, called an embryonic (em-bre-ON-ik) stem cell, can develop into any type of cell in the body. These cells aren't found in bone marrow.

Overview

Doctors use bone marrow tests to diagnose blood and bone marrow diseases and conditions, including:

  • Conditions in which a person produces too few or too many of certain types of blood cells
  • Problems with the structure of red blood cells
  • Bone marrow disorders, such as myelofibrosis (MI-eh-lo-fi-BRO-sis)
  • Some cancers, such as leukemia (lu-KE-me-ah)

Bone marrow tests also help doctors figure out how severe cancer is and how much it has spread in the body. The tests also are used to diagnose fevers and infections.

The two bone marrow tests are aspiration (as-pih-RA-shun) and biopsy.

Bone marrow aspiration usually is done first. For this test, your doctor removes a small sample of fluid bone marrow through a needle. He or she may have some idea of what the problem is, and the sample gives him or her useful information about the cells in the marrow.

A bone marrow biopsy is the followup test. It's done to provide more information about your cells. Also, a biopsy is done if your doctor wants to examine the bone marrow structure itself. For this test, your doctor uses a needle to remove a sample of bone marrow tissue.

Outlook

Bone marrow tests are fairly simple, and they're safe for most people. Complications are rare, but some people may develop bleeding or infections.

Sometimes bone marrow tests aren't safe for people who have certain bleeding disorders, such as hemophilia. Your doctor can tell you whether a bone marrow test is safe for you.




Who Needs Bone Marrow Tests?

Your doctor may recommend bone marrow tests if he or she thinks you have a blood or bone marrow disease or condition, such as:

  • Myelodysplastic (MI-eh-lo-dis-PLAST-ik) syndrome. This is a group of diseases in which your bone marrow doesn't make enough normal blood cells.
  • Neutropenia (NU-tro-PE-ne-ah). This is a condition in which you have a lower than normal number of white blood cells in your blood.
  • Anemia (uh-NEE-me-uh). Anemia occurs if you have a lower than normal number of red blood cells. The condition also can occur if your red blood cells don't have enough of an iron-rich protein that carries oxygen from the lungs to the rest of the body.
  • Aplastic anemia. This type of anemia occurs if your bone marrow doesn't make enough new blood cells (red blood cells, white blood cells, and platelets). Aplastic anemia is a rare, but serious condition.
  • Myelofibrosis. This is a serious bone marrow disorder that disrupts normal production of blood cells and leads to severe anemia.
  • Thrombocytopenia (THROM-bo-si-toe-PE-ne-ah). This is a group of conditions in which your body doesn't make enough platelets and your blood doesn't clot as it should.
  • Essential thrombocythemia (THROM-bo-si-THE-me-ah). This is a disease in which your bone marrow makes too many blood cells, especially platelets.
  • Leukemia. This is a cancer of the white blood cells. Types of leukemia include acute and chronic leukemias and multiple myeloma.

Your doctor also may recommend bone marrow tests if you have another type of cancer. Examples include breast cancer that has spread to the bone or Hodgkin's and non-Hodgkin's lymphomas (cancers of a certain type of white blood cell).

Bone marrow tests help show what stage the cancer is in. That is, the tests help doctors know how serious the cancer is and how much it has spread in the body.

Bone marrow tests also can show what's causing a fever. Doctors may recommend the tests for people who have diseases that affect the immune system. The tests also are used for patients who may have uncommon bacterial infections.




What To Expect Before Bone Marrow Tests

Before having bone marrow tests, a doctor, nurse, or physician assistant will explain the testing process and procedure and answer questions you might have.

Let your health care team know:

  • Whether you're allergic to any medicines
  • Whether you have a bleeding disorder
  • What medicines you're taking (you might have to stop taking some medicines, such as blood-thinning medicines, before having bone marrow tests)
  • Whether you're pregnant

Before the tests, you may be given medicine to help you relax. This medicine makes you sleepy, so you likely won't be able to drive after the test. Thus, your health care team may advise you to arrange a ride home.




What To Expect During Bone Marrow Tests

Bone marrow tests usually take about 30 minutes. The tests can be done in a hospital, doctor's office, or other health care facility.

Bone marrow tests generally are done on the pelvic bone. In most people, part of this bone is accessible on the lower back. If your doctor uses that part of the pelvic bone, you'll lie on your side or stomach for the test. Aspiration might be done on the breastbone.

Medicine will be used to numb the area where your doctor will insert the needle. Although you'll be awake during the tests, the medicine helps reduce pain.

If you're very nervous or anxious, your doctor may give you medicine to help you relax or sleep. If so, your health care team will closely check your breathing, heart rate, and blood pressure during the tests.

The area on your body where your doctor will insert the needle is cleaned and draped with a cloth. Your doctor will see only the site where the needle is inserted. He or she will make a small incision (cut) in your skin. This makes it easier to insert the needle into the bone. After the test, you might need stitches to close the cut.

For bone marrow aspiration, your doctor will insert the needle into the marrow and remove a sample of fluid bone marrow. You may feel a brief, sharp pain. The fluid that's removed from the bone marrow will be taken to a laboratory and studied under a microscope.

If your doctor decides to do a bone marrow biopsy, it will be done after the aspiration. For the biopsy, your doctor will use a needle to remove a sample of bone marrow tissue. Thin sections of this tissue will be studied under a microscope.

During both tests, it's important for you to remain still and as relaxed as possible (if you're awake).




What To Expect After Bone Marrow Tests

After the bone marrow tests, a nurse will hold a bandage on the site where the needle was inserted until the bleeding stops. Then he or she will put a smaller bandage on the site.

Most people can go home the same day as the tests. If you received medicine to help you relax during the tests, you may need to arrange a ride home.

After 24 hours, you can take off the bandage. Call your doctor if you develop a fever, have a lot of pain, or see redness, swelling, or discharge at the site. These are signs of infection.

Expect mild discomfort for about a week. Your doctor may tell you to take an over-the-counter pain medicine.




What Do Bone Marrow Tests Show?

Bone marrow tests show whether your bone marrow is making enough healthy blood cells. If it's not, the results can tell your doctor which cells are unhealthy and why.

Bone marrow tests are an important medical tool. They're used to diagnose many blood and bone marrow disorders, including anemia and certain kinds of cancer.

Bone marrow tests also are used to find out how severe cancer is and how much it has spread throughout the body. The tests also help doctors find the cause of fevers and infections.

Your doctor will combine information from your bone marrow tests with information from a physical exam, blood tests, and other tests, such as imaging scans and x rays. This information will help your doctor diagnose your condition and plan how to treat it.




What Are the Risks of Bone Marrow Tests?

Bone marrow tests are safe for most people. Complications are rare, but can occur. For example, some people develop bleeding or infections.

To prevent bleeding from the site where the needle was inserted, don't do any heavy lifting or vigorous exercise for a few days after the tests.

To prevent infections, don't shower or bathe for the first day after the tests. After 24 hours, you can take off the bandage. Call your doctor if you develop a fever, have a lot of pain, or see redness, swelling, or discharge at the site. These are signs of infection.

Expect mild discomfort for about a week. Your doctor may tell you to take an over-the-counter pain medicine.

Bone marrow tests might not be safe for people who have certain bleeding disorders, such as hemophilia. Your doctor can tell you whether bone marrow tests are safe for you.




Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to bone marrow tests or blood or bone marrow diseases, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.




Links to Other Information About Bone Marrow Tests

NHLBI Resources

Non-NHLBI Resources

Clinical Trials

 
December 20, 2011 Last Updated Icon

The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.