Bone Marrow Biopsy

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• Hematologic disorders such as leukemia, lymphoma, multiple myeloma, anemia, etc.

• Few if any
• Procedure can be performed in setting of thrombocytopenia
• Cellulitis at skin entry site or underlying soft tissue infection should prompt evaluation for different site

Preprocedural evaluation:
• H&P
• Prior imaging cross sectional imaging of the pelvis


Most common site for bone marrow biopsy is iliac wing.

CT guidance commonly used.
• Prone patient with posterior approach
• Advance needle along length of the iliac wing.
• For right iliac wing biopsy, operator stands on patient's left and skin entry site is midline with lateral trajectory
• Seat needle just beyond cortex. Occasionally, helpful to have mallet to assist with seating the needle beyond the cortex
• Remove inner stylet. Aspirate with large volume syringe (20 - 30 mL)
• Following aspiration, advance biopsy device without inner stylet into iliac wing 2-3 cm,
• Can be helpful to gently rock biopsy device to help capture specimen. Many devices have additional tools to assist with specimen capture

Following successful aspirate and bone biopsy,
• Hemostasis with compression
• Apply sterile dressing
• Option to take final pictures confirming no immediate post operative complication


• Rare
• Bleeding is most common
• Injury to surround structures
• Patient's can be sore 2-3 days following procedure
• Inadequate sample

• 15 minutes bedrest if local only
• Often times, moderate sedation will necessitate more recovery time than actual biopsy

Related Procedures

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[1] Cohen MG, McMahon CJ, Kung JW, Wu JS. Comparison of Battery-Powered and Manual Bone Biopsy Systems for Core Needle Biopsy of Sclerotic Bone Lesions. AJR Am J Roentgenol. 2016;206(5):W83‐W86. doi:10.2214/AJR.15.15067
[2] Lee RK, Ng AW, Griffith JF. CT-guided bone biopsy with a battery-powered drill system: preliminary results. AJR Am J Roentgenol. 2013;201(5):1093‐1095. doi:10.2214/AJR.12.10521
[3] BackTable, LLC (Producer). (2017, April 14). Ep 1 - BM BX Devices: Jamshidi vs OnControl [Audio podcast]. Retrieved from

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Arrow OnControl Bone Marrow Aspiration & Biopsy Procedure

A demonstration of bone marrow aspiration and biopsy using the Arrow(R) OnControl(R) System.

Bone Marrow Biopsy With OnControl Powered Bone Access System

Dr. Kevin Rice performs a bone marrow biopsy using the OnControl Bone Biopsy System.



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American Journal of Roentgenology (Nov 2013)

CT-Guided Bone Biopsy With a Battery-Powered Drill System: Preliminary Results

Standard percutaneous bone biopsy involves manual needle insertion. Recently, a battery-powered needle drilling biopsy system (OnControl) has been introduced. We report our experience using this drill biopsy system for CT-guided percutaneous bone biopsy in 25 patients.



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Dr. Aaron Fritts

Dr. Christopher Beck

Discussion of preferences in bone biopsy needles.



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