# Bone marrow aspirate and trephine biopsy: preparation, pain control and aftercare

Source: https://onco.cc/protocols/bone-marrow-aspirate-and-trephine-biopsy/  
OnCo record `bone-marrow-aspirate-and-trephine-biopsy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A bone marrow test takes a small sample of liquid marrow and a thin core of bone, usually from the back of the hip, to look for blood cancers or check treatment. It is done awake with local anaesthetic, sometimes with sedation or gas and air. Serious problems are rare (about 1 in 1,250 tests in a UK survey). Call the hospital for fever, a red or oozing wound, or pain that gets worse.

## Summary

No society guideline sets out how to do or prepare for the procedure; this page is built from the evidence that exists. Safety: British Society for Haematology surveys recorded 26 adverse events, including one death, in an estimated 54,890 biopsies from 1995 to 2001, and 16 adverse events in 19,259 procedures in 2003 (0.08%). Haemorrhage was the commonest and most serious, with myeloproliferative disorders, aspirin, other platelet dysfunction and thrombocytopenia the risk factors most often present (warfarin, disseminated intravascular coagulation and obesity also named). No source sets platelet or anticoagulant thresholds; plans are local.

Pain: under local anaesthetic, 70% report pain and 35% severe pain (methoxyflurane trial background). A 2024 meta-analysis of 18 randomised trials (1,017 people) found distraction (SMD -0.85), a powered biopsy system (SMD -0.27) and acupoint stimulation reduced pain, while hypnosis did not reach significance. Virtual reality was not significantly different from nitrous oxide/oxygen in REVEH (mean pain 3.0 against 3.5 of 10, n = 126). Inhaled methoxyflurane lowered worst pain against placebo (4.9 against 6.0). Sedation and gas and air (Entonox) are used in some UK hospitals. Rapid aspiration gave better specimens than slow aspiration at a cost of 1 point more pain on a 10-point scale.

Aftercare, as UK patient information describes it: eat and drink normally unless sedated, a dressing for 24 hours, pressure on any bleeding, mild painkillers for a few days' ache, no driving or alcohol for 24 hours after sedation with someone at home overnight, and a call to the 24-hour line for fever, a red or oozing site, feeling unwell or worsening pain.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: bone marrow biopsy; bone marrow test; bone marrow aspiration; BMAT; trephine biopsy; iliac crest biopsy; bone marrow aspirate

## Connected records

- cancers: [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Myelodysplastic syndromes / neoplasms (MDS)](https://onco.cc/cancers/mds/), [Myeloproliferative neoplasms (PV, ET, myelofibrosis)](https://onco.cc/cancers/myeloproliferative-neoplasms/)
- technologies: [Music therapy and music medicine](https://onco.cc/technologies/music-therapy-cancer/), [Powered bone marrow biopsy drivers (OnControl, BD Trek, OmniBone)](https://onco.cc/technologies/bone-marrow-biopsy-devices/)
- terms: [Biopsy](https://onco.cc/terms/biopsy/), [Bone marrow](https://onco.cc/terms/bone-marrow/)

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