Last updated: 11/24/2009

Examination of the bone marrow may be the next step that follows an abnormal clinical finding, such as an abnormal complete blood count (CBC), and/or an abnormal peripheral blood smear. It may also be performed following an abnormal bone image...

such as the finding of a lesion on x rays.

A biopsy of bone marrow shows the intact tissue, so that the structure of the fat cells, lymphocytes, plasma cells, fibrous connective tissue cells, and other cells, and their relationships to each other, can be seen. A bone marrow biopsy is used to:

• diagnose and manage any form of leukemia or other myeloproliferative condition such as multiple myeloma
• rule out or confirm bone marrow infiltration by malignancies such as Hodgkin's disease, non-Hodgkin's lymphoma, and metastatic carcinoma
• monitor the effects of chemotherapy and the response or lack of response to treatment of blood disease
• evaluate the success of bone marrow transplantation
• diagnose certain genetic diseases (e.g., lipid storage disease)
• investigate pancytopenia (a decrease of all blood cells in peripheral blood), neutropenia (decreased phagocytic white blood cells), or thrombocytopenia (decreased platelets)
• diagnose an infection of unknown origin
• investigate rare anemias for which a cause cannot be found or which does not respond to treatment as anticipated
• obtain intact bone marrow for laboratory analysis
• diagnose some types of cancer or anemia and other blood disorders
• identify the source of an unexplained fever (e.g., granulomatous lesions)
• diagnose fibrosis of bone marrow and myeloma when bone marrow aspiration has failed to provide an appropriate specimen

The combination of aspiration and biopsy procedures are commonly used to ensure the availability of the best possible bone marrow specimen. The aspirate is collected at the same time as the bone core biopsy by attaching a syringe to the bone marrow needle and withdrawing the sample before the cutting blades are inserted and the bone core is removed. The aspirate is the sample of choice for studying and classifying the nucleated blood cells of the bone marrow (e.g., determining the ratio of immature white blood cells to red blood cells (M:E ratio). The biopsy is the only sample that shows the blood forming cells in relation to the structural and connective tissue elements (i.e., the microarchitecture) of the bone marrow. It provides the best sample for evaluating the cellularity of the bone marrow (the percentage of blood-forming tissue versus fat).