Risks and Complications of Bone Marrow Procedures

The pain from a bone marrow procedure may vary among individuals. While some may experience dull soreness for a day or two, significant complications such as bleeding, infection, and prolonged pain are rare. It is important to note that this procedure should only be performed by experienced physicians using specialized bone marrow needles.

• Bone marrow biopsies are exclusively done on pelvic bones.
• Performing a bone marrow biopsy on the sternum is unsafe, so a specially designed needle with a guard is used for sternal marrow aspirations to prevent excessive depth.
• There is a possibility of bleeding problems or artery cuts at the site.
• In rare cases, fatalities have been reported during sternal marrow aspirations when the needle punctured the sternum and cut one of the heart’s surface arteries.

Some researchers utilize bone marrow aspirates for clinical trials to collect modified marrow cells for experimental treatments in various diseases.

Understanding Bone Marrow

Bone marrow is the soft spongy tissue found at the center of bones. It contains stem cells that give rise to red blood cells, white blood cells, and platelets in the blood. Additionally, the marrow can sometimes contain abnormal cells, proteins, or inflammatory reactions, including cancer cells in certain individuals. It also stores a supply of iron needed for the production of red blood cells. As we age, the percentage of fat in the marrow increases.

Exploring Bone Marrow Procedures

A bone marrow procedure, also known as bone marrow aspiration and/or biopsy, is a technique used to obtain a sample of the blood-forming portion of bone marrow for laboratory examination.

• Bone marrow aspiration involves inserting a special needle into a bone and suctioning out the marrow fluid.
• Bone marrow biopsy involves coring out a sample of the marrow with a saw-like instrument called a trephine.
• Both procedures provide valuable information about the marrow, with the biopsy offering a more comprehensive examination.

Medical Professionals Performing the Procedures

Internists, hematologists, oncologists, and transplant specialists are typically the doctors who perform bone marrow aspirates and/or biopsies.

Purposes of Bone Marrow Procedures

Bone marrow aspirations are primarily performed to diagnose blood cell-related conditions and detect cancers, while also studying cancer staging within the marrow. Moreover, these procedures can identify nonhematologic conditions, both cancerous and noncancerous. They also serve as a source of marrow cells for transplantation.

While bone marrow biopsies provide valuable insights into bone structure and related abnormalities, marrow aspirates offer a liquid sample revealing the cell population within the marrow. Both procedures are usually performed together, with an aspirate obtained before a biopsy.

Sampling Sites for Bone Marrow

The most common site for bone marrow sampling is the pelvic bone, specifically the posterior iliac crest. Other sampling sites include the pelvic bone near the groin and the sternum, although sternal sampling is only done in older individuals. The tibia is exclusively sampled in infants younger than one year.

Performing Bone Marrow Aspiration and Biopsy

A bone marrow procedure typically requires only local anesthesia, although some patients may need sedation. The physician makes a small incision, inserts a specialized hollow needle into the bone, and removes the marrow aspirate via suction. For the biopsy, the needle is rotated into the bone to cut a core that can be extracted from the needle. Stitches are usually unnecessary, and recovery is rapid.

The cost of a bone marrow aspiration and/or biopsy varies depending on location, insurance coverage, and country.

Source:

Bain, B.J. "Bone marrow aspiration." J. Clin. Pathol 54.9 September 2001: 657-663.

Chernecky, C., B. Berger, eds. Laboratory Tests and Diagnostic Procedures (Bone Marrow Biopsy), Philadelphia, PA: Elsevier Saunders, 2013: 241-244.

Radhakrishnan, N. "Bone Marrow Aspiration and Biopsy." Medscape. July 12, 2019.