Skip to Main Content


  • • Pancytopenia.

    • Unexplained anemia, leukopenia, or thrombocytopenia (aspiration only).

    • Acute or chronic leukemia (aspiration only).

    • Myelodysplasia.

    • Myeloproliferative disease.

    • Non-Hodgkin or Hodgkin lymphoma.

    • Childhood solid tumors (including sarcoma, Wilms tumor, neuroblastoma, germ cell tumor).

    • Bone marrow failure (including acquired aplastic anemia, Fanconi anemia, Diamond-Blackfan syndrome).

    • Fever of unknown origin.

    • Storage disease.

    • Monitoring during chemotherapy or following stem cell transplantation (aspiration only).




  • • Congenital factor deficiency or acquired coagulation defect.

    • Anticoagulation with warfarin or heparin.

    • Severe thrombocytopenia.

    • Infection or prior radiation at sample site.


Site Preparation


  • • 10% povidone-iodine.

    • Alcohol preparation pads or swabs.

    • Sterile gloves, gown, and drape.

    • Spinal and subcutaneous needles, 20 to 26 gauge.

    • 1% lidocaine hydrochloride, injection.

    • 8.4% sodium bicarbonate, injection, USP.


Marrow Aspiration and Biopsy


  • • Sodium heparin, injection, 1000 USP units/mL, preservative free.

    • Bone marrow aspiration needles (15 and 18 gauge, adjustable lengths).

    • Bone marrow biopsy needles (11 and 13 gauge, 4 or 2 inches in length).

    • Sterile syringes, 10 to 20 mL.

    • Container with fixative for trephine biopsy specimen.

    • Vacutainers; one for sodium heparin and one for ethylenediaminetetraacetic acid (EDTA).

    • Gauze sponges.

    • Bandages.


  • • Risk of bleeding is low if adequate pressure is provided over site to achieve primary hemostasis.

    • • Platelet transfusion is indicated when technical difficulties are anticipated in patients, especially those who are obese, with severe thrombocytopenia.

      • Defects in coagulation should be corrected before the procedure.

    • Risk of infection and osteomyelitis is extremely low when procedure is performed in sterile fashion.

    • Pain and discomfort are alleviated with adequate sedation and analgesics.

Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print

• Bone marrow examination provides critical information in the diagnosis of various hematologic and oncologic conditions in children.

• Bone marrow aspiration also permits immunophenotyping, cytogenetic analysis, and other molecular studies.


  • • Adolescents may require only local anesthesia for the procedure.

    • Conscious sedation or general anesthesia is generally necessary in young children, particularly if repeated procedures are required.

    • Adding local anesthesia in young patients also decreases postprocedural discomfort at the site.

    • Lidocaine used for local anesthesia should be buffered with sodium bicarbonate (sodium bicarbonate mixed with lidocaine in a 1:4 ratio) to reduce burning during injection.

    • Obtaining spicules (bone marrow particles rich in hematopoietic elements) on the first pull of the aspiration may be easier using a larger syringe (30 or 60 mL).

    • Aspirating more than 0.25 mL of marrow initially dilutes the sample with sinusoidal blood and interferes with morphologic studies.

    • If an aspirate is “dry” and an adequate specimen cannot be obtained, a touch imprint of the biopsy core may be helpful for cytologic examination.

    • A dry tap usually indicates myelofibrosis or a marrow ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.