Bone Marrow Puncture

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Bone Marrow Puncture
Bone Marrow Puncture

Video: Bone Marrow Puncture

Video: Bone Marrow Puncture
Video: Bone marrow aspiration and biopsy from the iliac crest • Oncolex 2023, March

Bone marrow puncture

During a bone marrow puncture, cells or tissues are removed from the bone marrow. This is done in the course of the diagnosis and follow-up of diseases that affect the blood and the hematopoietic system. The bone marrow is used, among other things, to produce blood. Different blood cells mature there and later find their way into the bloodstream.

The removal and examination of the bone marrow is necessary in order to clarify diseases in connection with the bone marrow, with blood cells and their formation. This can include anemia, leukemia and various changes and damage to the bone marrow. A removal of tissue - for example the bone - can also be carried out in the course of this procedure. In the context of the bone marrow puncture, only individual cells are removed, in the context of the so-called bone marrow punch, additional tissue.


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  • When is a bone marrow puncture or biopsy necessary?
  • What preparations are necessary?
  • How does the bone marrow puncture work?
  • What side effects / complications can occur?
  • Whom can I ask?

When is a bone marrow puncture or biopsy necessary?

Bone marrow puncture is required, for example, to diagnose:

  • Leukemia,
  • Anemia of unknown cause, megaloblastic anemia,
  • Leukocytopenia, leukocytosis,
  • Lymphadenopathy, splenomegaly, hepatomegaly of unknown cause,
  • Thrombocytopenia of unknown cause
  • multiple myeloma,
  • myelodysplastic syndrome (MDS),
  • Bone marrow metastases,
  • Lymphoma (staging, staging),
  • Waldenström macroglobulinemia as well
  • Storage diseases.

In the treatment of haematological diseases, a bone marrow analysis is carried out in order to assess the course of treatment and to be able to take measures based on the results - e.g. in the case of acute leukemia.

What preparations are necessary?

The patient's state of health is clarified in advance of a planned intervention. Among other things, it is essential to collect the patient's medical history (e.g. illnesses, taking medication such as blood-thinning medication, etc.). For example, if you suffer from bleeding disorders, you should definitely tell the doctor. Various tests are carried out (e.g. coagulation status). Before the planned bone marrow puncture, the doctor will inform you about the procedure and how it will proceed. Open questions can be clarified.

How does the bone marrow puncture work?

In the vast majority of cases, the procedure is performed on the pelvic bone (iliac crest) in adults, rarely on the sternum. In small children, the puncture is made on the shin bone, in older children on the iliac crest.

When puncturing the posterior iliac crest (posterior superior iliac spine), the patient lies on his / her side or on his / her stomach. The doctor will locate the puncture site and mark it. It is disinfected and covered with a sterile cover. The patient is given a local anesthetic (local anesthesia). A sedative can also be given if necessary. The doctor works under sterile conditions in order to avoid the spread of germs.

The bone marrow is obtained through depending on the indication

  • Aspiration (bone marrow puncture, aspiration cytology): A puncture is made and a small amount of bone marrow is sucked in via a special needle. After the needle has been removed again, a sterile bandage is applied and the puncture site is compressed by lying on the back or by compression with a sandbag. There may be a brief pain when inserting the needle and when sucking it. The removed material is prepared for further examination and then examined in the laboratory (cytological examination, ie regarding cells). A biopsy of additional tissue can also be performed in the course of this procedure.
  • Bone marrow punch: With the bone marrow punch, a larger special needle is advanced. A small cylinder with tissue can be obtained by turning it when pulling it out. This is also prepared for further examinations and examined histologically in the laboratory (bone marrow histology, ie regarding the tissue). After the samples are taken, a bandage is applied and compression is applied. The punch is performed, for example, when no marrow cells could be obtained by aspiration (so-called dry puncture) or, for example, when diagnosing malignant lymphomas (staging), aplastic anemia and MDS.

Blood pressure, pulse and oxygen saturation are monitored during and after the puncture. After the puncture, those affected have to lie down for a while. If a sedative and / or pain reliever has been administered, the ability to react is limited. For example, you are not allowed to drive a vehicle afterwards. Ideally, someone will accompany you home.

You can find more information in Laboratory Medicine at

  • Bone marrow cytology
  • Aspiration cytology

What side effects / complications can occur?

As with other examinations and treatments, a bone marrow puncture can have undesirable consequences. Various measures aim to avoid this. Before the puncture, the doctor will inform you about this, as well as the necessity and benefits. Affected people may be concerned about the idea of a puncture or bone marrow punch and a possible illness. However, the consequences of unexplained illnesses can be serious.

The undesirable consequences include:

  • Bleeding, bruises,
  • Infections as well
  • Perforations and injuries (e.g. to neighboring organs, nerves, blood vessels).

Whom can I ask?

A bone marrow puncture can be performed on an outpatient basis in the hospital or during an inpatient stay (internal medicine, hematology, oncology). Depending on the situation, an admission or referral certificate from the attending physician is required.

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