Chest
Clinical Investigations: Bronchos-Copy/LavageComplications of Fiberoptic Bronchoscopy in Thrombocytopenic Patients
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.
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Cited by (85)
International Society for Heart and Lung Transplantation consensus statement for the standardization of bronchoalveolar lavage in lung transplantation
2020, Journal of Heart and Lung TransplantationSociety of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe
2019, Journal of Vascular and Interventional RadiologyCitation Excerpt :The administration of blood components, such as red blood cells, plasma, platelets, cryoprecipitate, and other plasma derivatives, may be necessary to correct for coagulopathies in the periprocedural setting. Our knowledge regarding the impact of transfusion of plasma or platelets in the periprocedural setting is equivocal and is derived from small observational studies, retrospective case reviews, and consensus data (58,95–101). An exhaustive review of individual blood components and their mechanisms of action is beyond the scope of this paper; however, the properties of commonly used blood products are summarized in Table 5 (102).
Perioperative thrombocytopenia: evidence, evaluation, and emerging therapies
2019, British Journal of AnaesthesiaBronchoscopy and Bronchoalveolar Lavage in Pediatric Patients
2019, Kendig's Disorders of the Respiratory Tract in ChildrenSurgery and Hemostasis
2013, Consultative Hemostasis and Thrombosis: Third EditionConsensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions
2012, Journal of Vascular and Interventional RadiologyCitation Excerpt :Severe thrombocytopenia may result in an increased bleeding risk with image-guided interventions and open surgery, although the recommended threshold for platelet transfusion varies among procedures. As with the use of FFP, the literature data for platelet use are mostly from case series, retrospective case reviews, and consensus data (63–67). There are many etiologies of thrombocytopenia and significant variation in platelet function associated with patient comorbidities and medication use.
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