Bone Marrow Aspiration Is Where a Real Stem Cell Procedure Begins

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I remember the concept from my medical training that a process is only as good as the weakest link. That’s how I feel about bone marrow aspiration. Most physicians do this part poorly, compromising the entire stem cell procedure. Let me explain.

A Process and It’s Weakest Link

A game-changing statement appeared in Thomas Reid’s “Essays on the Intellectual Powers of Man,” published in 1786 which was, “‘A chain is as strong as its weakest link.” Since then this concept has been applied to everything from manufacturing to medicine. In the latter, if you have the best procedure in the world, but you don’t control for everything and one part is not up to snuff, the end outcome is impacted. That’s how I feel about “Bone Marrow Aspiration” and stem cell procedures.

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What Is Bone Marrow Aspiration?

A bone marrow stem cell procedure begins with a bone marrow aspiration (BMA). The doctor numbs up the area and places what looks like a thick needle into the bone marrow space. He or she draws out what looks like thick blood, which is called a bone marrow aspirate. That’s then processed in the lab to remove the stem cell fraction.

All BMA’s Are NOT Created Equal

We know a few things about BMA based on the published science:

  • There are the most stem cells in volume in the iliac crest
  • Taking multiple small volume pulls from various areas will yield more stem cells than one large pull

These are critical pieces of information for a patient to know because we still have physicians out there who will violate these rules to save time. As an example, they will take a large volume of bone marrow from a single site because that’s much faster. By doing that, the doctor is actually drawing mostly blood and not bone marrow aspirate and drastically reducing the number of cells taken.

If you want more in-depth information on this topic, see my video below:

New Research on BMAs

There was just a new scientific study that was published recently that continues to show that there are more stem cells in the iliac crest (pelvis) than the tibia (leg bone) (1). The study also found as we have, that the quality of the stem cells they recovered didn’t vary with older age, meaning the cells they got from older people performed as well in the lab as those from younger people.

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Making Sure You Get the Best BMA Possible

This is one of the most difficult things to ensure in all of regenerative medicine. For example, as a patient, you can make sure that your doctor uses a specific method to process cells (we use a lab) or whether he or she is qualified and will use x-ray or ultrasound guidance or both to place the cells in the right spot. However, for the BMA you’ll be lying face down on a table. However, here are the questions to ask the doctor:

  • How much volume do you take from one spot in the bone marrow? Right answer – no more than 5-10 ml. Wrong answer, 30 ml or more.
  • How many distinct spots in my bone marrow will you draw from? Right answer – 5-15 sites. Wrong answer – 1-2 sites
  • Will you use imaging guidance to draw the bone marrow? Right answer – Yes! Wrong answer – No, I don’t need it…

What We Do at Regenexx

All providers in our network have been trained on, and practice, high-quality BMA technique. So if you don’t feel like asking your doctor the above questions, just find a Regenexx provider here. 

The upshot? Controlling every aspect of the quality of the procedure is what we do at Regenexx. Hopefully, you can now see why based on the research!



(1) NeckaŘ P, Havlas V, LykovÁ D, BraniŠ J, KvÍzovÁ J, Bauer PO. Porovnání stromálních buněk kostní dřeně z různých anatomických lokací z hlediska jejich možného klinického využití [Comparison of Bone Marrow Stromal Cells from Different Anatomical Locations for Evaluation of Their Suitability for Potential Clinical Applications]. Acta Chir Orthop Traumatol Cech. 2020;87(3):183-190.

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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