Leukemia Patient Requires Amputation Following Bone Marrow Biopsy

This case involves a young stage III leukemia patient who received a delayed diagnosis and required an immediate bone marrow biopsy. After the procedure, the patient developed a hematoma in her right leg which rapidly progressed to compartment syndrome. The patient underwent multiple surgeries to resolve the hematoma, but amputation was the only option. It was alleged that a more timely diagnosis may have led to a better outcome for the patient. An expert in oncology with experience in bone marrow biopsy was sought to review the case and opine on the standard of care.

Question(s) For Expert Witness

1. How often do you perform bone marrow biopsies?

2. What are the most common complications?

Expert Witness Response E-034164

In my career, I estimate that I have personally performed about 2,000 bone marrow procedures. I spent the first 19 years of my career on the leukemia service at a nationally renowned cancer center where I directed the clinical research program in lymphoid leukemias. I treated thousands of patients with leukemia performing numerous bone marrow tests (about 150-200 per year) and training others in performing bone marrows. In addition, other members of my service also performed bone marrows and in the course of 19 years, I was aware of most of the complications seen in over 20,000 bone marrows performed. I was recruited to be the director of the heme malignancy and BMT program at another major medical center. In that role, I oversaw all aspects of clinical care for patients with bone marrow-based disease. I have recently retired from my clinical practice. Although I eventually stopped personally performing the test, I taught and evaluated others and was made aware of any complications from the procedure. I am experienced in legal review and have been retained as an expert witness 30-35 times during my 25 year academic career.