What is Bone Marrow Smear Examination? 

Bone marrow is a soft fatty tissue found inside the larger bones in our body. It has a sponge-like porous structure consisting mainly of a network of fibres surrounded by a liquid. This liquid is composed of blood cells and stem cells as well as vitamins and minerals, such as iron and vitamin B12. The red blood cells, white blood cells, platelets and cartilage are all produced within the bone marrow. Bone marrow also regulates the production of these cells. For example, if there is a depletion or deficiency of red blood cells in your body, the bone marrow will increase the production of these cells until the shortage is overcome. 

There are a number of health conditions which can impact the ability of the bone marrow to produce blood cells. These include vitamin and mineral deficiencies, leukaemia and genetic conditions. 

Doctors order a bone marrow smear test to make an assessment of the cells present in the bone marrow and to determine the cause of any abnormalities in the number of blood cells. 

  1. Why is a Bone Marrow Smear Examination performed?
  2. How do you prepare for a Bone Marrow Smear Examination?
  3. How is a Bone Marrow Smear Examination performed?
  4. What do Bone Marrow Smear Examination results mean?

Your doctor may order a bone marrow smear test if he suspects the following conditions or diseases:

This test is also advised in case of infections such as typhoid or infections related to HIV (human immunodeficiency virus). 

In case an individual has been diagnosed with cancer, the test may be done to determine the stage of cancer and evaluate the extent to which the cancer has spread. In cancer patients undergoing treatment, a bone marrow smear examination could be done at regular intervals to assess bone marrow function. 

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You do not require any special preparation for this test. However, if you are taking any medications or health supplements or have any allergies, then this must be communicated to the doctor before the test. Do not stop taking any routine medicine unless advised by the physician. Tell your doctor if you feel anxious before the procedure. He/she may give you a mild sedative.

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The test will be performed by a trained professional who, in most cases, will extract a sample from your hip bone.

  • You will be asked to lie down on your stomach or side so that your back is facing the doctor
  • The area from which the sample is to be drawn will be exposed and the surrounding area will be covered for your comfort
  • The site will be cleaned with an antiseptic solution and a local anaesthetic will be injected so that the site becomes numb
  • After this, the doctor will insert a fine needle through the skin and into the bone to draw out a bone marrow sample
  • Even though the site has been numbed, you may feel some uncomfortable pressure sensations 
  • Once the needle has been removed, a sterile bandage will be placed over the site 

This procedure will last only a few minutes. As an aftercare measure, you will be asked to keep the puncture site dry and covered for at least two days. In case the procedure is being performed on a child, general anaesthesia will be given before taking the sample.

Complications from the bone marrow smear examination are rare. However, there could be a risk of excessive bleeding, or infection at the puncture site. In such cases or in case of fever, a doctor should be consulted immediately.

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Normal results:

Normal test results indicate that you don’t have an abnormal number of cells in the bone marrow and no suspicious cells are found. 

Abnormal results:

Abnormal results may be obtained due to diseases of the bone marrow or due to the presence of certain types of cancers such as leukaemia or multiple myeloma. It may also be attributed to a deficiency of white blood cells. 

The doctor will conduct further tests in order to determine the cause of your symptoms.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.


  1. Chernecky CC, Berger BJ. Bone Marrow Aspiration Analysis- specimen (biopsy, bone marrow iron stain, iron stain, bone marrow). In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013: 241-244.
  2. Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017: chap 30.
  3. Memorial Sloan Kettering Cancer Center. Gerstner Sloan Kettering Graduate School of Biomedical Sciences [internet]. U.S. Bone Marrow Aspiration and Biopsy
  4. Leukemia and Lymphoma Society [internet]. New York (US). Bone Marrow Tests
  5. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Bone marrow aspiration

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