The cells in the blood and lymphatic system, in general, originate from stem cells in the bone marrow. In lymphoma and leukemia, as well as in some other tumors, a bone marrow examination is performed. In pediatrics, an aspiration and/or biopsy is taken from the iliac crest (hip bone). When doing a work-up for Hodgkin's lymphoma and some solid tumors, an aspirate and biopsy are taken from both sides. Sternal punctures are not performed on children.
In children, a bone marrow puncture is almost always performed under general anesthesia.
A bone marrow examination includes
- A smear for the primary work-up and later for monitoring of treatment response for leukemia or for evaluation of marrow involvement from lymphomas/solid tumors
- Aspirate samples for flow cytometry, cytogenetics, molecular genetics testing, and sometimes for research studies
- Peripheral blood smear
For diagnostics, the following is performed:
- Immunophenotyping (marker testing) using flow cytometry
- Cytogenetics (chromosome testing)
- Molecular genetic testing (for example PCR: polymerase chain reaction, FISH: fluorescence in situ hybridization)
- Special tests for research studies
- Lymphoma and leukemia
- Serious anemia
- Ambiguous bone pain/rheumatic symptoms
- Fever that is ambiguous
- Testing for possible tumor metastases in bone marrow
- Assessment of treatment effect
The only contraindication for a bone marrow biopsy is serious hemophilia. In this case, it must be performed in collaboration with a hemophilia clinic.
If treating with warfarin, INR should be ≤ 3.
NSAID/ASA treatment does not need to be postponed. Be aware of possible thrombocytopenia.
- Diagnose or exclude disease involvement of bone marrow
- Monitor response to treatment