My Doctor Ordered a Bone Marrow Biopsy: What Happens Next?

Although the name of the procedure may sound a bit nerve-racking, a bone marrow biopsy is a frequently performed and safe procedure. If blood levels are abnormal, or there is concern for certain types of cancer or bone marrow disorders, a bone marrow biopsy may be ordered.

During a bone marrow biopsy, a needle is inserted into a bone, usually in the hip area, and the marrow is drawn out. The marrow is then examined in the lab to see if it is functioning properly, or if any disease or infection is present.

Bone marrow biopsy

 Illustration by Cindy Chung, Verywell

This article will review the pain associated with a bone marrow biopsy and what test results may mean. 

Bone Marrow Biopsy

What Is Bone Marrow?

The bone marrow is the tissue inside the bone where blood cells are made. The marrow makes white blood cells that help fight infection, red blood cells that carry oxygen around the body, and platelets that clot the blood to prevent bleeding.

How Painful Is a Bone Marrow Biopsy?

A bone marrow biopsy can be an uncomfortable or painful procedure. The amount of pain can be different for each person, based on their pain tolerance and any anesthesia or sedation given for their procedure.

Controlling or preventing pain is an important step of the biopsy process, as the healthcare provider (typically a medical doctor) wants you to be as still as possible during the biopsy so it can be done as quickly and accurately as possible. 

At a minimum, local anesthesia is given in the skin and tissue where the biopsy will be taken. This numbs the area. With this injection, there may be a burning sensation as the numbing medicine goes in.

Some doctors will offer the procedure with additional anesthesia. This usually is not the same anesthesia used for open surgery, but rather a type of anesthesia called conscious sedation. With it, medications to reduce anxiety and pain are given through an intravenous line (IV).

This type of sedation allows you to breathe on your own, and possibly even be awake during the biopsy. This type of sedation makes the procedure much more comfortable.

Coping With Anxiety and Anticipatory Pain

Anxiety and anticipatory pain can lead to more pain than the procedure typically causes. One way to cope with the anxiety is to have a conversation with your healthcare team before the procedure. You can ask questions you may have and they can go through the procedure step by step so you know what to expect.

Techniques such as breathing exercises, mindfulness and distraction may be helpful in reducing pre-procedural anxiety. 

Studies have evaluated using music, lavender scent, and virtual reality as nondrug distraction techniques in the biopsy process.

In one study, the use of virtual reality during bone marrow biopsy was compared to the use of nitrous oxide for sedation. Pain scores were the same between the two groups, showing the use of virtual reality could be safe and effective in reducing pain and anxiety without the need for medication.

Goal of Bone Marrow Biopsy 

The goal of a bone marrow biopsy is to obtain bone marrow tissue for evaluation. It is used to look for a variety of conditions, often because of abnormal levels of white blood cells, red blood cells, or platelets. It can also be done to monitor treatment progress in conditions such as leukemia or lymphoma.

Conditions Diagnosed Through Test

Some conditions that can be diagnosed through a bone marrow biopsy can include:

Before Your Bone Marrow Biopsy

Exact instructions to follow before a bone marrow biopsy will be provided to you by your healthcare team. You can take preparations to be sure the procedure goes well and complications are minimized. Common preparation includes:

  • Ask any questions you may still have before the procedure starts.
  • Provide an accurate medical history for you and an updated list of allergies you may have. An up-to-date medication list will also be needed.
  • Arrange for a driver for the day of the procedure. If sedation is given, you won’t be allowed to drive home from the biopsy.
  • Follow instructions for eating/drinking. Often you may need to fast from food and drink for a period of several hours before your biopsy. Ensure you stay hydrated in the days before the procedure. 
  • Wear comfortable clothes and shoes to the procedure. You’ll likely have to change into a gown, and may want to wear something comfortable when the biopsy is finished. 

Step-by-Step What Happens During Aspiration and Extraction


Depending on why you’re needing the biopsy and which medical professional ordered it, it may be performed by a hematologist (doctor specializing in blood conditions), oncologist (doctor specializing in cancer), radiologist (doctor specializing in imaging), or one of their advanced practice providers.

The purpose is to sample bone marrow tissue along with a portion of bone. The procedure is usually about 30 minutes long.

The following is how a bone marrow biopsy is typically done:

  • Procedure preparation: After changing into a gown, you’ll be taken to the procedure room where you will lie on the procedure table. Vital signs will be taken, and you may have an IV placed in your arm for medications that may be administered during the procedure. Remember, if you get anesthesia it won’t make you completely asleep, but you’ll likely be relaxed and comfortable. 
  • Positioning: The most common site for a bone marrow biopsy is the hip bone. To be able to access this, you’ll be placed in a position in which your hip bone is up and easy for the provider to access. This will likely be lying on your side or stomach. 
  • Cleaning of the skin: The skin through which the bone marrow will be accessed is cleaned well to reduce the risk of infection. This may feel cold on your skin.
  • Local anesthesia: Local anesthesia (such as lidocaine) will be injected into the skin and tissues around the biopsy site to numb the area and help decrease pain during the biopsy. The injection may cause some burning as the medication goes in.
  • Needle insertion and sample collection: Once the skin is numb, a specialized needle will be inserted into the bone. The needle is pushed through to the marrow, and the marrow is then aspirated, or withdrawn. A pathologist in a lab will review the specimen. A small sample of bone may be taken as well for evaluation. The feeling you may have during this time has been described as a brief, sharp pain and some pressure. 
  • Finishing the biopsy: Once all of the samples have been taken, the needle is removed from the bone and skin. A sterile bandage will be placed on the skin of the insertion site. 
  • Recovery: Following the biopsy, you’ll be observed for a period of time before you’re allowed to return home. You’ll be provided a list of instructions to follow once you’re home. If you've been given sedation, you will need someone to drive you home.

After the Test (and When to Expect Results)

Once the procedure is over, you may have instructions to follow to ensure a successful and speedy recovery. Some common post-biopsy care includes:

  • Take it easy: Avoid strenuous activity for at least 24 hours after your biopsy. You may also be instructed to not lift heavy objects for a few days.  
  • Pain control: There may be some pain or soreness at the biopsy site for a few days after the procedure. Over-the-counter medications such as Advil (ibuprofen) or Tylenol (acetaminophen) are usually effective in managing this pain. 
  • Dressing care: Keep the dressing clean and dry. Don’t remove it until your healthcare provider tells you to. Evaluate the area to check for swelling, drainage, or warmth of the skin. If these symptoms are present, it may mean an infection is present. Notify your healthcare provider if you notice these symptoms.

When the biopsy is over, the marrow and bone are sent to a lab to be reviewed by a pathologist. The wait for results can be anywhere from a couple of days to a few weeks, depending on tests that need to be run on the bone marrow specimen. You may want to ask your provider when they will expect to have them back to review. 

Follow-Up After Bone Marrow Biopsy 

After the biopsy, you’ll likely be given an appointment to follow up with your healthcare provider. This may be in a few days or weeks depending on how long the results are expected to take.

The needle insertion site should heal in about a week or so. If you have any concerns or questions about how you’re healing, you should call your healthcare provider to discuss this as soon as you can. Don’t wait for your appointment if something is going on sooner. 

Negative Bone Marrow Biopsy Results 

If the bone marrow results are negative, then the bone marrow didn’t have any significant findings with all of the testing that was done. This may mean that certain diseases were not found. It may also mean that the bone marrow is functioning normally.

If the biopsy was done as treatment surveillance for leukemia, a negative biopsy means that there is no evidence of disease.

A negative bone marrow biopsy result may come as a relief, but it doesn’t mean there isn’t still something going on, especially if the biopsy was done as part of a workup for symptoms you’ve been having.

Ask your provider if there are any other tests or procedures that may need to happen now that the results of the biopsy are known. 

Positive Bone Marrow Biopsy Results

A positive bone marrow biopsy result means that there was something abnormal or concerning that was found in the bone marrow. The exact finding will be discussed by your healthcare provider, and can vary greatly.

It’s important to remember that even if a biopsy result is positive for an abnormality, this doesn’t necessarily mean that you will have a poor prognosis. Many bone marrow disorders are treatable. Once you have the results, discuss them with your healthcare provider to learn what this diagnosis means, and what treatment plan is needed. 

Summary 

A bone marrow biopsy is a procedure in which the bone marrow and part of a bone are removed to evaluate for any abnormalities. This may be done as part of a workup for abnormal blood tests or an evaluation for cancer.

It can be a painful procedure, but medications and anesthesia may be used to reduce the pain. Results may take up to a few weeks, and should be reviewed with your healthcare provider. 

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.