Chest
Volume 104, Issue 4, October 1993, Pages 1025-1028
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Clinical Investigations: Bronchos-Copy/Lavage
Complications of Fiberoptic Bronchoscopy in Thrombocytopenic Patients

https://doi.org/10.1378/chest.104.4.1025Get rights and content

Study objective

To determine the risk of epistaxis and pulmonary hemorrhage due to fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in the presence of thrombocytopenia.

Design

Prospective study of all patients undergoing FOB with BAL with a 4.9-mm-diameter bronchoscope after bone marrow transplantation (BMT) during a 6-month period.

Setting

A single BMT center.

Patients

Forty-seven BMT recipients undergoing 66 FOB with BAL. Thrombocytopenia (platelets <100,000/ml) was present in 58 (88 percent). Platelets were <50,000/ml in 44 (67 percent) and <20,000/ml in 13 (20 percent). In the thrombocytopenic patients, FOB with BAL was transnasal in 37 (64 percent), transoral in 5 (9 percent), and via endotracheal tube in 16 (28 percent).

Interventions

Fiberoptic bronchoscopy with BAL using a bronchoscope (Pentax FB-15H) (4.9-mm diameter). In one case, a pediatric bronchoscope (Pentax FB-10H; 3.5-min diameter) was used in a 7-year-old patient.

Measurements and results

The BAL was diagnostic in 22 of 47 patients studied (47 percent). Complications occurred in 7 of 58 (12 percent) thrombocytopenic patients (epistaxis and/or hemopty sis, 4; bradycardia, 2; bronchospasm, 1) of which all but 1 were minor and self-limiting. One life-threatening complication of severe epistaxis occurred during a transoral FOB in a patient with prior epistaxis (platelet count, 18,000/ml). One of 8 (13 percent) nonthrombocytopenic patients had hemoptysis. No patient had worsening fever or oxygenation at 4 h and no patient displayed worsening radiographic infiltrates suggestive of pulmonary hemorrhage attributable to the BAL at 24 h.

Conclusions

We conclude that transnasal FOB in thrombocytopenic patients was safe, being associated with minor airway bleeding in 3 of 37 patients (8 percent). In conclusion, FOB with BAL, even via the transnasal route, may be performed with relative safety despite the presence of significant thrombocytopenia.

Section snippets

Methods

We prospectively studied all bone marrow transplant (BMT) recipients undergoing diagnostic FOB with BAL during a 6-month period (January to June, 1991) at the Fred Hutchinson Cancer Research Center. Fiberoptic bronchoscopy with BAL was performed to determine the cause of pulmonar) infiltrates, hypoxemia, or worsening respiratory distress in the peritransplant setting. All procedures were perfoimed by a pulmonary fellow-in-training with the guidance of an attending physician trained in pulmonary

Ritient Characteristics

A total of 66 FOBs with BAL were performed in 47 patients over the 6-month period. The patient demographics are listed in Table 1. Eighty-nine percent of patients (42/47) were evaluated after BMT. The remaining 5 (12 percent) underwent FOB before BMT. Two of these patients underwent a second FOB after BMT. Fiberoptic bronchoscopy was performed at a median of 57 days after BMT (mean, 94 days; range, 0 to 1,041 days). The median number of days for FOB prior to BMT was 10 days (mean, 13 days;

Discussion

These data suggest that FOB with BAL is safe and efficacious despite thrombocytopenia. Complications occurred in only 7 of 58 (12 percent) patients with platelet counts less than 100,000/ml. Intensity of bleeding did not appear to be related either to the platelet count or to the level of uremia. Bronchoalveolar lavage did not appear to induce significant pulmonary hemorrhage. No patient experienced significant worsening of radiographic, respiratory, or hemodynamic parameters attributable to

Acknowledgments

We thank Drs. David Pierson and David Ralph for their reviews and comments.

References (13)

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This investigation was supported by Public Health Service Grants CA-18029. CA-47748. and CA-15704 from the National Cancer Institute

Presented in paît at the American Thoracic Societv National Meeting. Max 18. 1992

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