A bone marrow exam is a test that checks to see how well your bones are producing red or white blood cells. The marrow of your bones, which is the spongy part in the center of some of your larger bones, is responsible for producing red and white blood cells. During a bone marrow biopsy, a doctor will extract a small piece of the more solid part of the marrow using a needle. During a bone marrow aspiration, the doctor extracts the more liquid part of the marrow. Generally these are both done at the same time and can help diagnose or monitor vascular and marrow diseases, as well as certain cancers.
Quick Answer: A bone marrow biopsy is a short outpatient procedure in which a doctor uses a needle to take a small sample of liquid marrow (aspiration) and a thin core of solid marrow (biopsy), usually from the back or front of the hip bone. With local anesthetic and, if you wish, light IV sedation, most patients feel pressure and a brief pulling sensation rather than sharp pain. The procedure itself takes about 10 minutes, the hip may be sore for a few days, and results usually follow within days to a couple of weeks.
Bone marrow exams are a fairly simple procedure. The exam itself takes about 10 minutes, but the whole procedure, including preparation and post-procedure care takes a total of 30 minutes. These procedures can be performed at a hospital, clinic, or doctor’s office and are usually ordered by a hematologist or oncologist and performed by interventional radiologists or oncologists.
Before the procedure is conducted, your doctor will check your heart rate and blood pressure before giving you an anesthetic. In most cases, only local anesthesia is required, as the only sensitive part in bone is its outer lining called periosteum. At Premier Vein and Vascular Center, the periosteum of bone is numbed using ultrasound guidance which makes the procedure virtually painless after administration of local anesthetic. An IV anesthetic in order to partially or totally sedate the patient is also used to further alleviate anxiety and any discomfort.
Next, the procedure site is cleaned. The site is usually located at the top ridge on the front of a hip bone, but can sometimes be collected from the back of the hip. The patient is asked to lay on their back and then covered with a clean sterile cloth so only the procedure site is visible.
The aspiration test is usually conducted first, making a small cut and inserting the needle to reach the bone. Once the needle reaches bone, the doctor extracts some of the liquid. In rare cases, fluid is not extracted and the needle must be moved to another location. Several samples of the liquid marrow may be taken and the doctor will examine them to ensure the samples are viable for testing. The biopsy test uses a larger needle to extract some of the solid marrow.
Once both tests are complete, the needles are removed and pressure is applied to the incision to stop any bleeding. It is then bandaged up and the patient will be asked to lie on their back for 10 to 15 minutes while continuing to apply pressure to the incision site. Once the patient feels ready, they can get up and continue on with their day as normal. If the patient opts for an IV anesthetic over the local, they will need someone to drive them home and then rest for 24 hours.
The procedure site may feel tender for a couple of days after the exam, but your doctor may recommend some painkillers such as Tylenol. It is also recommended that the patient refrain from any rigorous exercise for a couple of days to reduce discomfort and possible bleeding. Keep the bandage on and dry for 24 hours after the exam. That means you cannot shower, bathe, or swim during that time. If the incision bleeds through your bandage and doesn’t stop when pressure is applied, you have a persistent fever, or increasing pain, swelling, redness, or drainage around the procedure site, contact your doctor.
Meet your vein specialist
Dr. Syed Raza, MD
Vascular & Interventional Radiology · Founder, Premier Vein & Vascular Center
Fellowship-trained interventional radiologist, board certified in diagnostic and interventional radiology with a Certificate of Added Qualification (CAQ) in interventional radiology, and a Fellow of the Royal College of Radiologists (UK). Member of SIR and RSNA. Former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, with 15+ years treating varicose veins, venous reflux and peripheral arterial disease.
Why Your Doctor Ordered a Bone Marrow Biopsy
Blood tests show what is circulating in your bloodstream, but they cannot always explain why the numbers are abnormal. Bone marrow is the factory where blood cells are made, so looking at it directly tells your hematologist or oncologist whether the factory is producing the right cells, in the right amounts, at the right stage of maturity.
Common reasons a bone marrow exam is requested include:
- Unexplained low red cells (anemia), low white cells or low platelets
- Abnormally high blood counts that suggest the marrow is overproducing cells
- Diagnosing or staging blood cancers such as leukemia, lymphoma and multiple myeloma
- Checking whether another cancer has spread to the bone marrow
- Monitoring how well chemotherapy or other treatment is working
- Investigating certain unexplained fevers, iron disorders or storage diseases
Being sent for a bone marrow exam can be worrying, and it is natural to assume the worst. Many biopsies are done to rule a condition out or to fine-tune a treatment plan, so the test itself does not mean a serious diagnosis.
Bone Marrow Aspiration vs Biopsy: What Each Sample Shows
The two samples are usually taken through the same small skin opening during one visit, but they answer different questions.
| Feature | Bone marrow aspiration | Bone marrow biopsy (core) |
|---|---|---|
| What is collected | A small amount of liquid marrow | A thin, solid cylinder of marrow and bone |
| What it shows best | Detail of individual cells and their maturity | The overall structure, how full the marrow is, scarring or infiltration |
| Common lab tests | Cell counts, flow cytometry, genetic and chromosome tests | Microscope examination of tissue, special stains |
| What you may feel | A brief, deep pulling sensation as fluid is drawn | Pressure as the needle is advanced |
| Typical result time | Some results within days | Often longer, as tissue needs processing |
Doing both together gives the most complete picture, which is why your doctor will usually request them at the same time.
How to Prepare for Your Bone Marrow Exam
- Medicines: tell us about blood thinners, aspirin, anti-inflammatory medicines and supplements such as fish oil. We will advise whether any should be paused and for how long, in coordination with the prescribing doctor. Never stop a blood thinner on your own.
- Blood counts: a recent platelet count and clotting test help us plan safely, especially if your platelets are low.
- Sedation: if you will receive IV sedation, avoid food for several hours beforehand as instructed and arrange for an adult to drive you home.
- Comfort: wear loose clothing, eat normally the day before, and bring a list of your medicines and allergies, including to latex, iodine or local anesthetic.
If you feel anxious, tell us. Knowing what will happen at each step, and having sedation available, makes a real difference for most patients.
What a Bone Marrow Biopsy Feels Like
Most patients are surprised that the experience is easier than they feared. The local anesthetic stings for a few seconds as it goes in. Because the sensitive lining of the bone is numbed carefully under ultrasound guidance, the main sensations afterward are pressure and pushing rather than sharp pain.
During the aspiration, many people notice a brief, deep pulling or dull ache in the hip that lasts only a few seconds while the liquid marrow is drawn. This is the part patients most often remember, and it passes quickly. For the core biopsy, you may feel firm pressure as the needle is advanced and gently rotated. Breathing slowly and letting the team know how you are doing throughout helps keep you comfortable, and we can pause at any point.
Why ultrasound guidance and an interventional radiologist help
Interventional radiologists perform image-guided needle procedures every day. Using ultrasound to see the bone surface allows the numbing medicine to be placed exactly where it is needed and the needle to be positioned precisely. This is especially helpful in larger patients, in people who have had previous biopsies, or when a sample was difficult to obtain before. Learn more about our ultrasound-guided procedures.
Risks and Possible Complications
A bone marrow exam is considered a low-risk procedure. Possible problems include:
- Soreness or bruising at the hip for a few days, the most common effect
- Minor bleeding at the site, which is more likely if platelets are low or blood thinners are taken
- Infection, which is uncommon thanks to sterile technique
- A reaction to the anesthetic or sedation
- Rarely, the need to repeat the test if a sample is not adequate for all the tests needed
We review your blood counts, medicines and medical history beforehand to keep these risks as low as possible.
Special situations we plan for
Some patients need extra planning. If your platelet count is very low, we may coordinate a platelet transfusion or time the procedure with your oncology team. If you have had radiation to the pelvis, the marrow on that side may be less active, so the other side or a different site may be chosen. In patients with a larger body build, ultrasound helps locate the bone accurately. And for people who have found previous biopsies difficult, we talk through sedation options in advance so the experience is better this time.
Getting Your Results
Your samples go to a pathology laboratory, where specialists examine them under the microscope and run additional tests requested by your hematologist or oncologist. Some basic findings may be ready within a few days, while detailed tissue, genetic and chromosome results can take longer, sometimes a couple of weeks.
Results are usually reviewed and explained by the doctor who ordered the test, because they fit into a bigger picture that includes your blood work, imaging and symptoms. It is a good idea to schedule or confirm that follow-up appointment before your biopsy day, so you know when to expect an answer.
How We Coordinate Your Bone Marrow Procedure
At Premier Vein & Vascular Center, bone marrow procedures are part of Dr. Syed Raza’s interventional radiology practice, and we work closely with referring hematologists and oncologists.
- Referral review. We review the request from your doctor, including which samples and laboratory tests are needed, so nothing is missed on the day.
- Health check. We go over your medical history, medicines, allergies and recent blood counts, and decide together whether local anesthesia alone or added IV sedation suits you best.
- Image-guided procedure. Ultrasound is used to numb the bone lining precisely and guide the needle, and samples are checked for adequacy before you leave.
- Clear aftercare. You go home with written instructions, a number to call, and your samples on their way to the laboratory, with results sent to your referring doctor.
Seek urgent medical care if you notice:
- Bleeding from the site that soaks through the bandage and does not stop after 10 minutes of firm pressure
- Fever of 100.4 F (38 C) or higher, chills, or spreading redness and pus at the site, especially if your white cell count is low
- Severe or rapidly increasing hip pain
- Dizziness, fainting or shortness of breath
Bone Marrow Biopsy in Houston
If your hematologist or oncologist has recommended a bone marrow exam, Dr. Syed Raza, a fellowship-trained interventional radiologist board certified in diagnostic and interventional radiology by the American Board of Radiology and a Fellow of the Royal College of Radiologists (UK), performs ultrasound-guided bone marrow aspiration and biopsy for patients across Houston and Katy. Our team also supports cancer care with port placement and other interventional oncology procedures. To schedule, ask your doctor to send a referral to our Houston interventional radiology clinic or call (832) 321-5355. Most insurance plans, including Medicare, are accepted.
Talk With a Specialist at Premier Vein
Have questions about your symptoms or treatment options? Dr. Syed Raza and the team at Premier Vein & Vascular Center can evaluate your concerns and explain your options clearly. Same-week appointments are usually available, and most insurance plans are accepted.
Frequently Asked Questions
How painful is a bone marrow biopsy?
Most patients describe pressure and a brief deep pulling sensation during the aspiration rather than sharp pain. Careful numbing of the bone lining, especially under ultrasound guidance, and optional IV sedation make the procedure tolerable for most people.
How long does it take to get bone marrow biopsy results?
Some initial results may be available within a few days, while more detailed tissue, genetic and chromosome tests can take up to a couple of weeks. The doctor who ordered the test will usually go over the results with you.
Can I drive after a bone marrow biopsy?
If you only had local anesthesia, many people can drive home. If you received IV sedation, you will need an adult to drive you and should avoid driving for the rest of the day.
Where on the body is a bone marrow biopsy taken?
In adults it is usually taken from the back of the pelvic bone near the top of the buttock, or sometimes from the front of the hip bone. These areas are close to the skin and contain plenty of active marrow.
Do I need to stop blood thinners before a bone marrow biopsy?
Sometimes. It depends on the medicine, why you take it and your blood counts. Our team will coordinate with your prescribing doctor and give clear instructions, so do not stop a blood thinner on your own.
Is a bone marrow biopsy only done for cancer?
No. It is also used to investigate unexplained anemia, low or high blood counts, certain infections and iron or storage disorders, and to check how well treatment is working. Needing one does not by itself mean you have cancer.
Will I need another bone marrow biopsy later?
Some people do. Repeat bone marrow exams are often used to check how well treatment for a blood disorder or cancer is working, or to confirm remission. Your hematologist or oncologist will explain whether and when a repeat test is needed.