1. Bone marrow aspiration may be performed under local anaesthesia alone, but short acting intravenous benzodiazepines (e.g. midazolam) may be administered—with appropriate monitoring (pulse oximetry), oxygen administration and available resuscitation equipment—when trephine biopsy is performed. General anaesthesia rarely used (except in children).

2. Best position is with patient in L or R lateral position.

3. Skin and periosteum over the posterior iliac spine are infiltrated with local anaesthetic.

4. A small cutaneous incision is made, the aspirating needle is introduced through this and should penetrate the marrow cortex 3-10mm before removal of the trocar.

5. No more than 0.5-1mL marrow should be aspirated initially, and smears made promptly.

6. Further material can be aspirated and placed in EDTA or other anticoagulant media for other studies.

7. An Islam or Jamshidi needle is preferred for trephine biopsy.

8. The needle is advanced through the same puncture site to penetrate the cortex.

9. The trocar is removed and using firm hand pressure the needle is rotated clockwise and should be advanced as far as possible.

10. The needle is removed by gentle anti-clockwise rotation. In this manner an experienced operator should regularly obtain biopsy samples of 25-35mm in length.

11. Simple pressure dressings are sufficient aftercare and minor discomfort at the location may be dealt with by simple analgesia such as paracetamol.

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