Bone Marrow (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- What is bone marrow?
- What is a bone marrow procedure (aspiration and/or biopsy)?
- What types of doctors perform bone marrow aspirates and/or bone marrow biopsies?
- Why are bone marrow biopsies or aspirations done?
- What bone is used to sample the bone marrow?
- How is a bone marrow aspiration and/or biopsy performed?
- What is done with the bone marrow sample?
- What diseases are diagnosed by bone marrow examination?
- What are the risks or complications of a bone marrow procedure?
What diseases are diagnosed by bone marrow examination?
A wide variety of conditions can be diagnosed by examination of the bone marrow. The following examples illustrate some of the most frequent conditions, but there are many more. The presence or absence of cancer in the bone marrow can determine what treatments are recommended to a patient with cancer known to be elsewhere in the body. Some cancers (leukemia, multiple myeloma) arise from cells in the marrow, so this is where the biopsy must be taken to confirm the diagnosis. Other cancers, like lymphomas, can spread to the bones. A low blood-clotting element (platelet count) in the blood (thrombocytopenia) can be due to several causes. It is important to establish whether or not the cells that make the platelets (megakaryocytes) are still present in the marrow (idiopathic thrombocytopenic purpura [ITP]) or are gone (along with most other bone marrow cells as in aplastic anemia). Most cases of anemia (low red blood cells) can be diagnosed by simple blood tests. When these tests are negative, examining the marrow can reveal problems with the red blood cells that are uncommon causes of anemia (sideroblastic anemia, aplastic anemia). Persistent fevers can be caused by infections that reside in the marrow (atypical mycobacteria, brucellosis) and a sample of the marrow may provide the best source of culture material.
What are the risks or complications of a bone marrow procedure?
Different individuals feel the pain caused by injection of the local anesthetic and the remainder of the procedure to a variable extent. There may be dull soreness for a day or two. Significant complications are very unusual but can include bleeding and infection and prolonged pain. This procedure is only done by experienced physicians using special bone marrow needles. Bone marrow biopsies are done almost exclusively from pelvic bones. It is unsafe to perform a bone marrow biopsy on the sternum, so a special needle with a guard on it is used for sternal marrow aspirations to prevent the needle from going too deep.
Rare fatalities have been reported, usually during sternal marrow aspirations when the needle has penetrated the sternum and cut one of the arteries on the surface of the heart.
Wise-Draper, T. "Bone Marrow Aspiration and Biopsy." Medscape.com. Mar. 31, 2015. <http://emedicine.medscape.com/article/207575-overview>.
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