What is a bone marrow test used to diagnose?

Bone marrow, the spongy tissue found within the hollow centres of our bones, plays an important role in producing various blood cells, including red blood cells, white blood cells, and platelets. When our body’s blood cell production is disrupted a healthcare professional may recommend a bone marrow test to investigate the underlying cause. These specialised procedures, known as bone marrow aspiration and biopsy, allow doctors to collect and analyse samples of bone marrow, providing information into a wide range of medical conditions. Let us take a look at these tests further in this guide.

What is bone marrow?

Bone marrowbone is the manufacturing site for our body’s essential blood cells. It is located within the hollow centres of our larger bones, such as the hip, sternum, and vertebrae. This spongy material is responsible for generating red blood cells, which carry oxygen, white blood cells, which defend against infections, and platelets, which aid in blood clotting.

Why is it important?

The production of these cells occurs within the bone marrow, making it a crucial component of our overall health and well-being. When something disrupts the normal functioning of this tissue, it can lead to a wide range of blood-related disorders, including anaemia, leukaemia, lymphoma, and myeloma, among others.

Why do I need a bone marrow test?

Healthcare providers may recommend a bone marrow test for a variety of reasons including:

• A bone marrow test can help identify the underlying cause, such as anaemia, leukaemia, or thrombocytopenia after a blood test reveals an abnormal number of red blood cells, white blood cells, or platelets
• Certain blood disorders, like aplastic anaemia, polycythemia vera, and myelodysplastic syndrome, can be diagnosed through a bone marrow test, as they often involve disruptions in the normal production and maturation of blood cells
• For individuals with known or suspected cancers that affect the blood or bone marrow, such as leukaemia, lymphoma, and multiple myeloma, a bone marrow test can help determine the stage of the disease and monitor the effectiveness of ongoing treatment
• In cases where a patient is experiencing unexplained symptoms, such as fever, fatigue, or weight loss, a bone marrow test may be ordered to rule out underlying conditions, including infections or secondary cancers that have spread to the bone marrow
• Before a stem cell or bone marrow transplant, a bone marrow test may be performed to evaluate the compatibility between the donor and recipient, ensuring the best possible match for a successful transplant

By understanding the various reasons for undergoing a bone marrow test, patients can better prepare for the procedure and engage in meaningful discussions with their healthcare providers about their specific medical concerns and the role of this diagnostic tool in their care.

The bone marrow aspiration and biopsy procedures

Bone marrow tests typically involve two complementary procedures: a bone marrow aspiration and a bone marrow biopsy. These tests are usually performed together to provide a comprehensive assessment of the bone marrow’s composition and function.

Preparing for a bone marrow test

Before undergoing a bone marrow aspiration and biopsy, patients will receive detailed instructions from their healthcare provider on how to prepare. This may include:

• Medication medical history review
• Fasting for some tests
• Arranging transportation after the procedure
• Discussing concerns

By following the pre-procedure instructions and communicating openly with their medical team, patients can help ensure a smooth and well-managed bone marrow testing experience.

The bone marrow test procedure

On the day of the bone marrow test, patients will typically be asked to change into a hospital gown and lie on their side or stomach, depending on the location of the biopsy site. The healthcare provider will then clean the skin with an antiseptic solution and administer a local anaesthetic to numb the area.

Bone marrow aspiration

During a bone marrow aspiration, a healthcare provider, often from the Hematology or Oncology department, uses a hollow, thin needle to extract a small sample of the liquid portion of the bone marrow. This procedure is usually performed on the back of the hip bone, known as the posterior iliac crest or sometimes the breast bone.

The process begins with the administration of a local anaesthetic to numb the area, followed by the insertion of the needle into the bone. Using a syringe attached to the needle, the provider then draws out a small amount of bone marrow fluid and cells. Patients may experience a brief, sharp pain during this part of the procedure, but the discomfort is usually well-managed with the numbing medication.

Bone marrow biopsy

Immediately after the aspiration, the healthcare provider will perform a bone marrow biopsy. This procedure involves the removal of bone marrow cells again from the breast bone or pelvic bone.

The procedure involves a small incision in the skin and insertion of a specialised biopsy needle into the bone. By twisting and rotating the needle, they can extract a small piece of bone marrow tissue. Patients may feel a sense of pressure or discomfort during this part of the test, but the local anaesthetic helps to minimise any significant pain.

The entire process usually takes around 30 minutes to complete. Patients are typically able to return home the same day, although they may be advised to avoid strenuous activities for a short time to allow the biopsy site to heal.

Risks and complications

While bone marrow tests are generally considered safe, there are a few potential risks and complications that patients should be aware of:

• Bleeding: There is a small risk of excessive bleeding from the biopsy site, which can usually be managed by applying pressure
• Infection: Although uncommon, there is a slight risk of infection at the biopsy site. Patients should monitor the area for signs of redness, swelling, or fever and report any concerns to their healthcare provider
• Pain and discomfort: While the local anaesthetic helps to minimise discomfort, some patients may experience mild to moderate pain or discomfort during and after the procedure. Over-the-counter pain relievers can be taken
• Nerve damage: In extremely rare cases, the biopsy needle may damage a nearby nerve, leading to temporary or permanent tingling, numbness, or weakness in the affected area

Conclusion

Bone marrow tests, including aspiration and biopsy procedures, are diagnostic tools that are useful to diagnose blood disorders, cancers, or other conditions that may affect the bone marrow. These procedures present a small risk but it is the only way to obtain precise enough information about some serious causes of abnormal blood cell production.

Sources

• Bone Marrow Biopsy: What It Is, Procedure & Results
• Bone Marrow Tests: MedlinePlus Medical Test
• Bone marrow test – Tests and scans – Cancer Research UK