A Reading on

BONE MARROW ASPIRATION

In Partial Fulfillment of the

Requirements in NCM 212 – RLE

IMMUNOLOGY / CANCER ROTATION

Submitted to:
Prof. Aldrin Antone, RN, MN
Clinical Instructor

Submitted by:
Fhey Bernadette M. Beltran, St. N
BSN 3C – GROUP 3

August 22, 2022

Title: Professional accountability in a sternal bone marrow aspiration: a forensic case
report

Bibliography: Bardaa, S., Karray, N., Hammanmi, Z., et. Al (2020). Professional
accountability in a sternal bone marrow aspiration: a forensic case report. Pan African
Medical Journal, 36(255), 1-6.

Summary:

A forensic case centralizes the death on a table of a 73-year-old man who

underwent a diagnostic procedure: Sternum Bone Marrow Aspiration. As per numerous
medical studies, bone marrow aspiration is one of the many offered invasive medical
procedures which is facilitative when diagnosing patients for hematological, oncological,
and other foreign infectious diseases which are not done through standard biological
diagnostics. Not to mention, bone marrow aspiration can be done in various sites such as
the Posterior Iliac Crest and Sternum. However, this procedure upholds austere
contraindications, such as unbalanced homeostasis, results of severe thrombocytopenia,
radiation history of the skin, especially on the puncture site, and even minimal skin
infections. As for the prerequisites, patients are advised to have a chest x-ray showing
any sternal bone complications. Along with that are the legally signed consent and waiver
form from the patient after pondering the whole idea of the procedure. Given that this is
an invasive procedure, major and minor complications may occur, such as puncture site
bleeding and infection, and rarely lead to fatal complications due to ascendant aorta
injury. In this case, a geriatric patient came to the hospital due to severe vertigo
associated with asthenia and cutaneous mucosa pallor with a medical history of Diabetes
Mellitus. Also, the patient's biological results revealed severe anemia with 3g/dL,
hyperproteinemia, and a platelet count of 180,000 mg/dL. With this, multiple myeloma
was suspected, whereby the physician ordered sternal bone marrow aspiration to confirm
the hypothesis. In the progress of the procedure, bleeding was observed, followed by a
complaint of severe pain and episodes of bradycardia and hypotension. Minutes after, the
patient lost consciousness; therefore, resuscitation was performed. However, declared
"dead-on-the-table" after 40 minutes.
 As the family was grieving for their loss, they could not help but ponder on the
thought of having an autopsy, for which, prior to the procedure, the patient was able to
follow the proper guidelines and contraindications. With that, the autopsy result shows a
wound injury at the anterior face of the sternum with a visible bruise over the pericardium
sac, which leads to blood clot formation inside. This bone marrow aspiration is a simple
invasive procedure, although it still imposes patients' possible injuries peculiarly when
aspiration is done near the heart and large vessels. The hospital liability shows that the
aortic wound injury can be held as a technical error due to the doctor's lack of expertise
in performing the aspiration. That said, the hospital was sued for malpractice and
involuntarily violated the integrity of the patient's body resulting in a table death.

Reaction:

There is no doubt that medical health workers always commit to doing their job
with utmost accuracy and respect to the human body. However, this does not guarantee
a patient's continuous success and good progress. Even so, this does not condone a
patient's death brought by medical malpractice or technical errors from the said
procedures. With this case, it does not solely centralize the idea of medical accountability
brought by technical errors; instead, I wanted to ponder the thought of how simple yet
complex the Bone Marrow Aspiration procedure is in a way that this might cause
significant complications to other body organs. Although, given the limited exposure I
have, there are only a few items I can quickly grasp and understand, precisely the
purpose, contraindications, and prerequisites needed when having Bone Marrow
Aspiration. Regarding the totality of the article, there are a few items I would agree with,
mainly concerning the medical and nursing management and ethical protocols the
hospital applies. On the other hand, having said about the medical liability of the medical
health worker brought by a result in the autopsy revealing a technical error committed
during the procedure leading for cardiac tamponade is something that is not in my
expertise as a student nurse, given that this scopes a broad aspect of medical procedure.

In corresponds with the institution I am practicing with, regardless of how simple

or complex, each procedure is, we are taught to see patients holistically, where everything
is applied to their safety and well-being. Through this article, I understand the significance
of enhancing and instilling student nurses with competent nursing skills, especially when
conducting procedures that observe strict, complex technicalities such as invasive
procedures. Also, medical health practitioners should never be lax and dependent on
biological diagnostics alone and should always verify and be certain before making
decisions for the patient. With the concern of that issue, it is given that not all surgeries
and diagnostics go well on how it is planned despite proper guidelines being followed. In
cases where failure to resuscitate and major complications occur, medical health
professionals are always the center of accountability for assumptions such as medical
malpractice happens. However, having that kind of thought of point blaming "medical
malpractice" on health workers should not be conventionalized, for this affects how well
and confident they do in their profession.

Moreover, I was raised in a big and happy family in which I am very affectionate
towards my cousins and nephews. When I was in school age, it is still very distinct in my
memory that my mother would often bring me to her work, wherein I got to spend my day
with her staff, and sometimes I got to play with their son and daughter during the day.
With that, I was able to build a friendship, though years have passed, and we lost touch.
Presently, I got devastating news – I was informed that one of my past friend was
diagnosed with Leukemia. Although, we were not able to see each other even up to this
time, given that she is restricted from having any visitors considering that she is
immunocompromised. Her earliest symptoms were unknown fever, frequent nosebleeds,
and rapid weight loss; therefore, her family immediately consulted their physician and was
then advised to have a bone marrow aspiration. After that, my family and I lost track of
her, but one thing is for sure – she is in deep pain and currently fighting for her life.

Furthermore, some content of this article might impose a false perspective on

others, especially regarding medical accountability brought by technical errors of the
procedure. People may think that there are instances where malpractices and technical
errors in a patient cannot be helped, but as long as a person is willing to take full
responsibility for their action, then this too shall pass. With that being said, I beg to
disagree with this thought, for there is no patient who deserves to die on the table, given
that it is a simple invasive procedure. Being responsible for your negligence does not
equate to repentance of your actions, for people will never understand how depressing
and outrageous this can be to the family and even to a patient's life. Every health
professional should be cautious about a diagnosis that leads to death due to technical
errors brought by the procedure. Nevertheless, there is always a good note for everything.
This article can serve as a warning and reminder to everybody to practice being keen on
details and procedures before making a conclusive decision for the patients. As to student
nurses, this article can be an eye-opener to become more cautious and patient-centered,
especially for immunocompromised patients. Lastly, this article contains procedures and
guidelines about how bone marrow aspiration is being done, which is very advantageous
if patients with the same concern are encountered in the hospital.

Being a responsible student nurse means dealing with unexpected cases, allotting
most of your time to our patients, and being devoted to the hospital's principle, which is
to offer optimum care to patients. It is easier said than done, but once nurses put
everything per what they believe is right and just for their patients, malpractices, and
errors are wholly eradicated. This article contains information widely studied in our field
of profession that can help modify more effective interventions and health teachings for
patients undergoing bone marrow aspiration. Furthermore, this article is advantageous
for future researchers to comprehensively study how to minimize pain levels during bone
marrow aspiration procedures, especially for pediatric patients. Also, researchers can
study and invent materials used in the BMA procedure that would minimize incidents and
errors throughout the procedure. Along with that, students and healthcare professionals
can utilize this article to create thorough studies with additional prerequisites aside from
biological diagnostics and x-rays to verify and corroborate a patient's clearance to
undergo invasive procedures regardless of how simple or complex it is may be. Lastly,
this is vital for the Immunology and Cancer Rotations to better understand the total
concept of Bone Marrow Aspiration, most significantly on how this is being done. This
gives significance to the rotation by helping us practice our decisive, accurate, and
patient-centered skills.