【Major points】
  1. Bone marrow examination is for understanding the hematopoietic functions and cell types of the bone marrow to serve as references for disease diagnosis.
  2. You do not have to fast on the day of the bone marrow examination. Please empty your bladder first and wear loose-fitting clothes.
  3. After the bone marrow examination , you need to lie down and pressurize the puncture site for 1 to 2 hours until there is no bleeding.
  4. You must avoid contacting with water before the wound heals and change the dressing daily until the wound heals.
I. What is bone marrow examination?
      Bone marrow examination is the extraction of bone marrow fluid or bone marrow tissue from the sternum (rare) or ilium for biopsy to understand the hematopoietic functions and cell types of the bone marrow and to then provide the physician with such information as references for diagnosis and treatment.
II. Preparation before examination:
  1. After being given an explanation by your physician, you will be given the bone marrow examination consent form for filling out.
  2. You do not need to fast on the day of the bone marrow examination and should wear loose-fitting clothes.
  3. Please urinate before the bone marrow examination.
  4. The examination staff will help you lie on your side (in shrimp posture) or flat (rarely) to facilitate the examination (Figure 1).
  5. Before the bone marrow examination, the physician will inject a local anesthetic into your bone marrow puncture site to relieve discomfort and then insert a puncture needle into the bone marrow cavity to extract the bone marrow tissue.
  6. You may experience local soreness during the process. At this time, you may take a deep breath to relax the muscles of the whole body and relieve tension. Do not twist your body or reach out to touch the puncture site to avoid wound contamination or puncture failure. The process takes about 20 to 30 minutes. If you feel unbearable discomfort, please inform the healthcare staff present immediately.
              Figure 1 Shrimp posture

III. Principles of care after examination:
  1. After the bone marrow examination, you must lie down and pressurize the puncture site for around 1 to 2 hours until there is no bleeding. Try not to get out of bed during the pressurization process, until the healthcare staff confirms that there is no bleeding at the puncture site.
  2. If you feel that the wound is wet, then it means that the wound may be bleeding. Please inform the healthcare staff immediately to observe the wound.
  3. You may feel a dull pain or soreness at the puncture site, which can be relieved in about 2~3 days and rarely lasts for more than a week; if the pain is too severe to bear, then please inform the healthcare staff.
  4. To avoid infection, you are requested to keep the wound at the puncture site clean and dry and avoid contact with water until the wound heals.
  5. Before the wound heals, the dressing should be changed daily, and the wound should be observed. If you find that the wound is bleeding again, swollen, or has secretions, please inform the healthcare staff immediately.

  1. Gilotra, M., Gupta, M., Singh, S., & Sen, R. (2017). Comparison of bone marrow aspiration cytology with bone marrow trephine biopsy histopathology: An observational study. Journal of Laboratory Physicians, 9(3), 182-189. https://doi.org/10.4103/JLP.JLP_117_16
  2. Kaufman, C. S., Kuo, K. T., & Anand, K. (2021). Image guided bone marrow biopsy. Techniques in Vascular and Interventional Radiology, 24(3), 100771. https://doi.org/10.1016/j.tvir.2021.100771
  3. Stenstrup, E., Skendzel, S., Warlick, E., & Parran, L. (2017). Reducing the risk of sedation for adult bone marrow biopsy patients: establishing a new protocol to support pain control and anxiolysis. Biology of Blood and Marrow Transplantation, 23(3), 391-452. https://doi.org/10.1016/j.bbmt.2016.12.536 
  4. Yang, R. K., Nazeef, M., Patel, S. S., Mattison, R., Yang, D. T., Ranheim, E. A., & Leith, C. P. (2018). Improving bone marrow biopsy quality through peer discussion and data comparisons: A single institution experience. International Journal of Laboratory Hematology, 40(4), 419-426. https://doi.org/10.1111/ijlh.12804
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