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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.
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.
Why: Bleeding is the main serious risk, and it was seen mostly in people on aspirin, with low platelets or with certain marrow disorders.
“The major risk factors for haemorrhage, in order of frequency, were diagnosis of a myeloproliferative disorder, aspirin treatment, other putative platelet dysfunctions, and thrombocytopenia.”
Bain, Journal of Clinical Pathology (British Society for Haematology survey) 2005 · National adverse event survey (ungraded)
Why: Knowing that serious problems are rare, and which ones to watch for, helps people decide and cope.
“Sixteen adverse events were reported, representing 0.08% of total reported procedures.”
Bain, Journal of Clinical Pathology (British Society for Haematology survey) 2005 · National adverse event survey (ungraded)
Why: Local anaesthetic alone does not need an empty stomach; sedation does.
“You are usually able to eat and drink before your test.”
Cancer Research UK 2025 · Patient information (ungraded)
Why: Many people still feel pain with local anaesthetic alone, and a third describe it as severe.
“Pain during bone marrow biopsy (BMB) under local anaesthesia (LA) is reported in 70% of patients, of whom 35% rate the pain as severe.”
BMJ Supportive & Palliative Care 2014 · Randomised trial background statement (ungraded)
Why: In trials, distraction lowered pain without drugs or side effects.
“Distraction, powered bone marrow biopsy system and acupoint stimulation are effective in reducing pain among patients undergoing bone marrow aspiration and biopsy.”
Journal of Clinical Nursing 2024 · Systematic review and meta-analysis of randomised trials (GRADE certainty not stated in the abstract)
Why: A fast pull draws up more marrow and gives a better sample, so the test is less likely to need repeating.
“We propose that the R-technique is preferable to the S-technique due to better specimen quality.”
Acta Haematologica 2016 · Randomised trial (ungraded)
Why: Most oozing stops with firm pressure; bleeding that continues needs checking.
“You have a dressing over the site, which you should keep on for 24 hours. If you notice any bleeding apply pressure to the area. If it doesn't stop, contact your hospital 24 hour advice line.”
Cancer Research UK 2025 · Patient information (ungraded)
Why: Sedatives affect judgement and reactions for longer than people feel.
“If you have sedation, you’ll need someone to take you home and stay with you overnight. Also, for 24 hours after, you shouldn’t drive, drink alcohol, or operate heavy machinery.”
Cancer Research UK 2025 · Patient information (ungraded)
Why: These are signs of infection or bleeding under the skin, which are rare but need treatment.
“If you have severe pain or it's getting worse then you should contact the hospital.”
Cancer Research UK 2025 · Patient information (ungraded)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
There is no graded guideline for performing or preparing for bone marrow biopsy; the best-supported elements are: a bleeding history focused on aspirin, other antiplatelet and anticoagulant drugs, thrombocytopenia and myeloproliferative disorders (BSH surveys, where these were the commonest factors in haemorrhage, the main serious complication at about 0.08% of procedures); local anaesthetic with an offer of additional analgesia or sedation, since most people still feel pain; and distraction, which a 2024 meta-analysis of randomised trials found effective. Virtual reality and nitrous oxide/oxygen were similar in one phase 3 trial. Aftercare as described by UK patient information is consensus practice without trial evidence.
Bain, Journal of Clinical Pathology (British Society for Haematology survey) 2005 · Bain, British Journal of Haematology 2003 · Journal of Clinical Nursing 2024 · Journal of Medical Internet Research 2023 · BMJ Supportive & Palliative Care 2014 · Cancer Research UK 2025
Where it differs: An inhaled gas mixture breathed by the patient during the procedure, used in some UK and French centres instead of or alongside sedation.
Evidence: REVEH (126 patients): mean pain 3.5 of 10 with nitrous oxide/oxygen and 3.0 with virtual reality, not significantly different; all also had lidocaine. Cancer Research UK notes some hospitals use gas and air instead of sedation.
Journal of Medical Internet Research 2023 · Cancer Research UK 2025
Where it differs: A self-administered handheld inhaler licensed in Australia for short procedures.
Evidence: Randomised, double-blind trial of 100 patients with cancer: worst pain 4.90 against 6.0 with placebo (p = 0.011).
Where it differs: A battery-powered driver turns the needle into the bone instead of manual pressure and rotation.
Evidence: In the 2024 meta-analysis, powered systems reduced pain modestly (SMD -0.27, 95% CI -0.53 to -0.003).
Where it differs: The operator calls each patient the day after and a week after to ask about adverse events.
Evidence: Described as a competency measure in a training guideline; no outcome evidence.
Jackson et al., Journal of the Advanced Practitioner in Oncology 2012
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Adverse events, including one death, in UK biopsies 1995 to 2001 “A total of 26 adverse events, including one death directly attributable to the procedure, were reported among an estimated 54 890 biopsies.” | National postal survey (ungraded) | Bain, British Journal of Haematology 2003 |
| Distraction reduced pain “The pooled results revealed statistically significant pain reduction effects using distraction (SMD: -.845, 95% CI: -1.344 to -.346, p < .001)” | Meta-analysis of randomised trials | Journal of Clinical Nursing 2024 |
| Virtual reality and nitrous oxide/oxygen gave similar pain “The average pain intensity was 3.5 (SD 2.6, 95% CI -1.6 to 8.6) for the MEOPA group and 3.0 (SD 2.4, 95% CI -1.7 to 7.7) for the VR group” | Phase 3 randomised trial | Journal of Medical Internet Research 2023 |
Shares Myeloproliferative neoplasms (PV, ET, myelofibrosis), Myelodysplastic syndromes / neoplasms (MDS), Acute myeloid leukaemia.
Shares Myeloproliferative neoplasms (PV, ET, myelofibrosis), Myelodysplastic syndromes / neoplasms (MDS), Acute myeloid leukaemia, Multiple myeloma.
Shares Powered bone marrow biopsy drivers (OnControl, BD Trek, OmniBone), Myelodysplastic syndromes / neoplasms (MDS), Acute myeloid leukaemia, Multiple myeloma.
Shares Myeloproliferative neoplasms (PV, ET, myelofibrosis), Myelodysplastic syndromes / neoplasms (MDS), Acute myeloid leukaemia.
Shares Myeloproliferative neoplasms (PV, ET, myelofibrosis), Myelodysplastic syndromes / neoplasms (MDS), Acute myeloid leukaemia, Multiple myeloma.
Shares Myeloproliferative neoplasms (PV, ET, myelofibrosis), Myelodysplastic syndromes / neoplasms (MDS).
Shares Myeloproliferative neoplasms (PV, ET, myelofibrosis), Myelodysplastic syndromes / neoplasms (MDS), Acute myeloid leukaemia.
Shares Myeloproliferative neoplasms (PV, ET, myelofibrosis), Myelodysplastic syndromes / neoplasms (MDS).