Background: In sickle cell disease, bone involvement is the commonest clinical presentation in the acute as well as chronic setting presenting as painful vaso-occlusive crisis and avascular necrosis respectively. Other complications include bone marrow necrosis and infarction.
Case Report: We report a case of a 20 year old male who was referred for bone marrow evaluation due to symptoms of fever, weakness and repeated episodes of bone pains. Bone trephine biopsy revealed multiple areas of central necrosis surrounded by fibroblasts.
Conclusions: Recognition of necrosis through bone trephine biopsy is important for early institution of therapy.

Keywords: sickle cell, Necrosis, Bone Marrow