Last Updated on November 17, 2025 by Ugurkan Demir

At Liv Hospital, we know how key a bone marrow puncture procedure is. It helps diagnose and treat blood-related diseases. This includes bone marrow aspiration and biopsy. The bone marrow puncture procedure is vital for collecting tissue from bones where blood cells are made.

Key Takeaways

• Bone marrow aspiration removes a small amount of liquid bone marrow with a thin needle.
• A bone marrow biopsy takes a small piece of bone tissue and the marrow inside for tests.
• Common places for the procedure are the back of the pelvis, the front of the pelvis, and sometimes the sternum or lower leg in young kids.
• The test is used to diagnose anemia, blood disorders, and some cancers.
• It also helps find out how far a disease has spread and if treatment is working.

Understanding Bone Marrow Examination

Bone marrow examination uses different methods to diagnose and treat diseases. It’s key to understanding blood cell production and spotting disorders. This helps in treating many conditions.

Defining Bone Marrow Aspiration and Biopsy

Bone marrow aspiration takes out the liquid part of the marrow. A bone marrow biopsy removes the solid part. Aspiration shows the cell types, while biopsy gives a detailed marrow structure.

These tests are usually done together for a full marrow condition check. The posterior iliac crest is the main site. But the sternum and tibia might be used too.

Diagnostic and Therapeutic Applications

Bone marrow examination has many uses. It helps diagnose and treat diseases. Here are some main uses:

• Diagnosing blood cancers like leukemia and lymphoma
• Looking into low blood cell counts
• Checking if cancer has spread to the marrow
• Seeing if treatments for blood disorders are working

Healthcare providers use bone marrow test results to create specific treatment plans. This meets each patient’s unique needs.

Clinical Indications for Bone Marrow Examination

Bone marrow aspiration and biopsy are key for diagnosing and managing blood disorders. They give vital information about the bone marrow’s cells and how they work. This helps doctors diagnose and keep track of different conditions.

Hematologic Malignancies

Diagnosing and staging hematologic malignancies like leukemia, lymphoma, and multiple myeloma is a main reason for bone marrow tests. The National Center for Biotechnology Information says these tests are key. They give detailed information about the cells and structure of the bone marrow.

For example, bone marrow tests help find out what kind of leukemia someone has. They also show how much of the marrow is affected. This info is key to knowing how serious the disease is and what treatment to use.

Unexplained Cytopenias and Marrow Disorders

Bone marrow tests are also used to check for unexplained cytopenias, like anemia or low blood counts. They help find the cause, like marrow failure or diseases that fill up the marrow.

These tests can also diagnose other marrow problems, like aplastic anemia or myelofibrosis. They give insights into the marrow’s cell count and shape. This helps doctors diagnose and manage these conditions.

Other Medical Indications

Besides blood cancers and low blood counts, bone marrow tests have other uses. They can help diagnose and track certain infections, like visceral leishmaniasis or mycobacterial infections. They can spot pathogens in the marrow.

Also, bone marrow tests can help figure out what’s causing unexplained fever, weight loss, or other symptoms. They can find conditions that other tests might miss.

Bone Marrow Puncture Procedure: Anatomical Sites

Medical professionals need to know the different sites for bone marrow puncture. The right site is key for a successful procedure and patient comfort.

The best position for bone marrow aspiration is usually prone or lateral decubitus. This ensures access and comfort. The American Cancer Society says the posterior iliac crest is the most common site.

Posterior Iliac Crest: Primary Site

The posterior iliac crest is the top choice for bone marrow aspiration and biopsy. It’s easy to access and gives high-quality marrow samples. This site makes the procedure simpler and lowers the risk of problems.

• Easy access to the marrow cavity
• High-quality marrow samples
• Lower risk of complications compared to other sites

Sternum: Alternative Approach

The sternum is another site for bone marrow aspiration. But it’s not without risks. There’s a chance of major complications like cardiac or major vessel injury.

When considering sternal aspiration, think about:

1. Patient selection based on anatomical and clinical factors
2. Precise technique to minimize risk
3. Adequate training and experience for the practitioner

Anterior Iliac Crest and Tibia: Special Considerations

The anterior iliac crest and tibia are also sites for bone marrow aspiration. The anterior iliac crest is used when the posterior crest is not accessible. The tibia is more common in pediatric patients.

Site	Advantages	Disadvantages
Posterior Iliac Crest	Easy access, high-quality samples	It may be uncomfortable for some patients
Sternum	Alternatively, when other sites are not accessible	Higher risk of serious complications
Anterior Iliac Crest	Useful when the posterior crest is not accessible	May have variable marrow quality
Tibia	Used in pediatric patients	Limited applicability in adults

In conclusion, picking the right site for bone marrow puncture is a big decision. It depends on the patient’s anatomy, the clinical situation, and the practitioner’s skills.

Patient Positioning Techniques

Bone marrow aspiration needs precise patient positioning for safety and success. The right position helps access the site, reduces pain, and lowers risks.

Prone Position for Posterior Iliac Crest

The prone position is often used for the posterior iliac crest. Patients lie on their stomachs with a pillow under their hips. This raises the posterior iliac crest for easier access.

Lateral Decubitus Position

Some patients prefer the lateral decubitus position, lying on their side. It’s good for those who can’t lie prone or for other sites. The patient must be comfortable and stable for safe needle placement.

Positioning for Alternative Sites

For sites like the sternum or anterior iliac crest, positioning changes. For a sternal aspiration, the patient lies on their back. A pillow under their shoulders arches the chest, improving access.

Important things to consider in patient positioning include:

• Keeping the patient comfortable to avoid movement
• Ensuring good access to the site
• Respecting the patient’s dignity and modesty
• Monitoring the patient’s condition easily

Healthcare providers can make patient positioning better for bone marrow aspiration. This improves both the safety and the success of the procedure.

Equipment and Materials Required

To do a bone marrow aspiration and biopsy, doctors need special equipment and materials. The right tools are key for safety, success, and getting accurate results.

Aspiration and Biopsy Needles

The main tool for these procedures is the needle. Aspiration needles get bone marrow, while biopsy needles take a bone sample. Needles vary in size and type, with some being thrown away after use and others cleaned and reused.

Guidelines say it’s important to pick the right needle for the job and the patient. The size of the needle might change based on the patient’s bone and the procedure’s needs.

Anesthesia and Sterilization Supplies

Local anesthesia is key for comfort during the procedure. We use lidocaine to numb the area.

Sterilization supplies are also vital to avoid infection. This includes gloves, drapes, and antiseptic solutions. Sometimes, we use pre-packaged kits for convenience.

Specimen Collection Materials

After getting the bone marrow, we need the right specimen collection materials. This includes tubes for the aspirate, fixative for the biopsy, and special containers for lab transport.

It’s important to handle and label these samples correctly. This ensures accurate lab results and diagnosis.

Equipment/Material	Description	Purpose
Aspiration Needles	Various sizes and types	Aspirate bone marrow
Biopsy Needles	Different gauges and lengths	Obtain a core bone marrow sample
Local Anesthetics	Lidocaine or similar	Anesthetize the puncture site
Sterilization Supplies	Gloves, drapes, antiseptics	Maintain asepsis
Specimen Containers	Sterile tubes, fixative solutions	Collect and preserve specimens

Pre-Procedure Preparation

Before a bone marrow aspiration, we must prepare carefully. This ensures the patient’s safety and the success of the procedure. We will go over the important steps next.

Patient Assessment and Informed Consent

We start by checking the patient’s medical history and current health. We look for any risks the procedure might have. Informed consent is given after explaining the procedure’s risks and benefits. This makes sure the patient knows what to expect.

The Cleveland Clinic says patients get assessed and consent before the procedure. This builds trust and makes sure the patient understands the procedure’s impact.

Coagulation Status Evaluation

Checking the patient’s coagulation status is key. We look at their bleeding risks by checking their coagulation profile. This includes prothrombin time (PT) and activated partial thromboplastin time (aPTT).

We also check the patient’s platelet count and any anticoagulant medications. This helps us understand any bleeding risks and how to manage them.

Aseptic Technique Preparation

Using aseptic technique is vital to avoid infection. We sterilize the equipment and prepare the skin at the puncture site. We also use sterile drapes to keep the area clean.

By following these steps, we can lower the risks of bone marrow aspiration. This ensures a good outcome for the patient.

Step-by-Step Bone Marrow Aspiration Technique

We will walk you through the bone marrow aspiration process. This method is used for both diagnosis and treatment. It involves several key steps to ensure a safe and accurate test.

Local Anesthesia Administration

The first step is to give local anesthesia to reduce pain. We use a local anesthetic to numb the skin and tissues at the site.

The anesthetic is injected with a fine needle. The area is then cleaned and prepared. It’s important to numb the area well for the patient’s comfort.

Needle Insertion Technique

After numbing, we insert the needle. The bone marrow aspiration needle goes through the skin and into the bone. We usually use the posterior iliac crest for this.

We insert the needle gently and twist until it reaches the marrow. Then, we remove the stylet and start the aspiration.

Aspiration Process

The aspiration process uses negative pressure to collect marrow. This is done by attaching a syringe to the needle.

The marrow is then analyzed for various tests. These include cytological examination, flow cytometry, and molecular studies.

Specimen Collection and Handling

Specimen collection is a vital part of the procedure. We handle the marrow carefully to avoid contamination.

The specimens are labeled and sent to the lab for analysis. It’s important to handle and transport them properly for accurate results.

Step	Description	Key Considerations
Local Anesthesia	Administration of a local anesthetic	Ensure adequate numbing
Needle Insertion	Insertion of an aspiration needle into the bone	Use a gentle, twisting motion
Aspiration	Application of negative pressure	Collect a sufficient marrow sample
Specimen Handling	Handling and labeling of marrow specimens	Prevent contamination, ensure proper labeling

Bone Marrow Biopsy Procedure

The bone marrow biopsy procedure is key to diagnosing diseases. It removes a sample of solid bone marrow tissue. This is vital for finding out what’s wrong with the blood (Source: Mayo Clinic).

Iliac Crest Approach

We often choose the iliac crest for bone marrow biopsies. It’s easy to reach and gives good samples. The posterior iliac crest is the top choice because it’s full of marrow tissue. Doctors say it’s the best spot because it’s big and easy to get to.

Core Biopsy Extraction

We use a special needle to get a core biopsy sample. The core biopsy extraction method involves twisting the needle to get a solid piece of marrow. This is important for getting a good sample for tests.

Specimen Processing

After we get the sample, it’s sent for tests. First, it’s fixed in a special solution. Then, it’s treated to remove calcium and put in wax. After that, it’s cut into thin slices and stained for a microscope.

Post-Procedure Care and Complications Management

The time after a bone marrow test is very important. We need to watch our patients closely and give them the right care. This helps avoid any problems.

Immediate Post-Procedure Monitoring

We watch for any bad reactions right after the test. Close observation is key in the first hours. This helps us catch and fix any issues fast.

Potential Complications

Even though bone marrow tests are usually safe, there are risks. These include:

• Bleeding or hematoma formation at the puncture site
• Infection, though rare with clean techniques
• Pain or discomfort at the procedure site
• Rarely, more serious complications like fractures or nerve damage

Management of Complications

Stopping problems before they start is key. We make sure patients are ready and know how to care for themselves after. If a problem does happen, prompt action is taken. For example, if there’s bleeding, we apply pressure and watch the patient’s health.

By giving good care after the test and being ready for any issues, we can keep our patients safe. This way, we make sure they get the best results from their bone marrow test.

Conclusion

We’ve covered the steps and sites for bone marrow puncture procedures. They are key in diagnosing and managing blood-related conditions. The American Cancer Society highlights its importance.

The procedure requires careful patient positioning and the right anatomical sites. It also needs a precise technique to get the right samples. Knowing when to do a bone marrow exam is vital for doctors.

Healthcare providers can make accurate diagnoses and manage patients better by following these guidelines. Proper care after the procedure and managing any complications are also critical.

As we move forward in hematology, bone marrow punctures will keep being essential. We must keep improving our methods and patient care through better diagnosis and treatment.

FAQ

Reference:

British Society for Haematology audit on bone marrow biopsy complications, PMC, 2004. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770618