Bone marrow aspiration

Last Updated December 20th, 2021

What is bone marrow aspiration?

The bone marrow is a special spongy tissue that is found in the center of the larger bones in the body. The tissue functions as a major hematopoietic organ and is responsible for the generation of red blood cells, white blood cells and platelets. These cells function in various important ways; the WBCs help fight infection, RBCs carry oxygen and nutrients in the body and the platelets enable the blood to clot. The amount of these cells produced depends on the requirement of the body. At the same time, old cells are continuously broken down and replaced by the newly generated cells.

Bone marrow aspiration is a process where a sample of the same is withdrawn from the bone in a liquid form and the necessary tests are done. The sample is generally collected from the hip bone or the lower end of the spine where the bone is closer to the skin. Bone marrow aspiration is often combined with a bone marrow biopsy and the entire process is termed as a comprehensive bone marrow examination. The process looks into the type, quantity, and maturity level of the cells present in the marrow and evaluates the overall structure of the marrow.

Why do I need to undergo a bone marrow aspiration?

In some cases, a complete blood count (CBC) can indicate the presence of an abnormal number of the white and red blood cells and the doctor can order for a bone marrow test to find out the cause. It helps the doctors to determine and diagnose a few particular types of diseases and conditions listed below.

– Blood cancers, including leukemia, lymphoma, or multiple myeloma.
Stem cell disorders.
– To diagnose severe anemia or thrombocytopenia (low platelet count).
– Hemochromatosis, which is a genetic disorder.
– Determining the root cause of an unknown fever.
– Specific storage diseases, such as amyloidosis or Gaucher’s disease.
– For determining the stage or progression of a disease like cancer.
– To check the patient’s response to treatment for a bone marrow related condition or cancer.
– The process is also ordered for undergoing treatments like stem cell transplant or chromosomal analysis.

How is the bone marrow aspiration performed?

The bone marrow is generally collected from the hip bones for adult patients. In case the test is done for a child, a leg bone or a bone in the spine may be used. The area is numbed by a local anesthetic and you may be given a mild sedative if needed. The process is carried out in a hospital or a special clinic and takes around 30 minutes.

– You will be asked to change into a hospital gown and then you will need to lie on your side or on your stomach on a table.

– Before the procedure, your heart rate and blood pressure will be checked by the doctor.

– You might be given a sedative to help you relax.

– The area is disinfected by antiseptics and covered with sterile gauze. It is then numbed by a local anesthetic.

– The doctor then inserts a special needle into the bone and a small amount of the liquid portion of the bone marrow is sucked out into the tube attached to it.

– The needle is withdrawn and pressure is applied to the area to prevent bleeding.

– The area is then bandaged and you are asked to rest for 15-20 minutes before moving out of the clinic.

– For those who undergo a bone marrow biopsy, a larger needle is used that removes a small section of the solid bone tissue and marrow for testing. Slight pain or a mild stinging sensation during the test is normal.

What is the price for a bone marrow aspiration in India? 

The cost of the bone marrow aspiration varies from Rs. 500 to 5000, depending on the center and the quality of the facilities involved.

When will I get the test results?

The test results are usually delivered within 2 to 3 days depending on the clinic or hospital.

What is the normal range for bone marrow aspiration?

The technicians determine three main aspects of the bone marrow through this test, which are mentioned under.

– The myeloid/erythroid or M/E ratio which compares the myeloid cells (WBC precursors) to erythroid cells (RBC precursors).

– Whether the WBC, RBC, platelet-producing cells are in the right stage of maturity and are present in the right proportion.

– The presence of any abnormal cells in the marrow, like leukemia or tumor cells.

The charts provided below indicates the normal range of bone marrow components in a healthy adult.

Cell Type

Normal Adult Range Bone Marrow %
Blast 0.1 – 1.7
Promyelo 1.9 – 4.7
Myelo 8.5 – 16.9
Metamyelo 7.1 – 24.7
Band 9.4  – 15.4
Seg 3.8 – 11
Eos Myelo 0.2 – 1.4
Eos 0.2 – 6
Baso 0 – 0.2
Lymph 8.6 – 23.8
Plasma Cell 0 – 3.5
Mono 0 – 0.6
Mast Cells
0 – 0.2
Histio 0 – 0.8
Pronormo 0.1 – 1.1
Baso. Normo 0.4 – 2.4
Poly Normo 13.1 – 30.1
Ortho Normo 0.3 – 3.7

What do the results mean?

Abnormal reports can be a symptom of leukemia which can be of various forms. Other than that, the abnormal results can also indicate the following ailments.

– The bone marrow is not making enough blood cells resulting in anemia or a blood disorder.

– Cancer of the lymph tissue (Hodgkin or non-Hodgkin lymphoma).

– A severe bacterial or fungal infection in the body.

– A bleeding disorder called idiopathic thrombocytopenic purpura (ITP)

– A particular disorder where not enough healthy blood cells are made.

Depending on the results, the doctor will evaluate the situation and discuss the conditions with you to prescribe the right treatment. Further tests can also be ordered if needed.

How many people suffer from blood cancer in India?

India ranks 3rd in the number of blood cancer patients in global terms, after China and the USA. There are almost 20 different kinds of blood cancers out of which leukemia is the 9th most common form of blood cancer reported in India. It has been estimated that every year almost 200 bone marrow transplants are performed in Indian hospitals.

Do I need to fast for the bone marrow aspiration?

No restriction on eating is necessary for undergoing a bone marrow aspiration test.

What else do I need to know before I appear for a bone marrow aspiration?

Some patients find the process of bone marrow withdrawals lightly painful and it might be accompanied by a feeling of light-headedness. There can also be a slight tingling sensation in the leg which usually goes away in a few hours. It is necessary to keep the bandage in place for 24 hours and seek the doctor’s advice before consuming any pain-killers.

It is normal to feel some discomfort and stiffness accompanied by bruising at the collection point for a few days. If you have been sedated for the test, you will need someone to guide you home and you should not drive, drink alcohol, operate heavy machinery in the next 24 hours. You may see a blood spot on the dressing after the test, which is normal.

The process may also require some restrictions on the intake of particular medicines like blood thinners. You need to consult with your doctor for any medicine that you might be currently consuming before appearing for the process. Any infections from the process are extremely rare but if you experience redness or bleeding at the collection site, a fever or increasing pain, you need to inform your doctor immediately.

Can pregnant women undergo bone marrow aspiration?

If you are pregnant you need to discuss it with the doctor and follow the advice given.

Is bone marrow aspiration possible for new-born babies?

The process is possible for new-borns and the tibia is a satisfactory collection point for infants and children under 2 years of age. In many cases, the test is done by putting the child to sleep by using a sedative.

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