Chest, Vol 104, 1025-1028, Copyright © 1993 by American College of Chest Physicians

ARTICLES

Complications of fiberoptic bronchoscopy in thrombocytopenic patients

SM Weiss, RC Hert, FJ Gianola, JG Clark and SW Crawford
Fred Hutchinson Cancer Research Center, Seattle.

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-mm 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 hemoptysis, 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.

This article has been cited by other articles:

				D. R. Ouellette The safety of bronchoscopy in a pulmonary fellowship program. Chest, October 1, 2006; 130(4): 1185 - 1190. [Abstract] [Full Text] [PDF]

				C. M. Samama, R. Djoudi, T. Lecompte, N. Nathan-Denizot, J.-F. Schved, and the AFSSAPS Expert Group Perioperative platelet transfusion: recommendations of the Agence francaise de securite sanitaire des produits de sante (AFSSaPS) 2003: [Transfusion perioperatoire de plaquettes : recommandations de l'Agence francaise de securite sanitaire des produits de sante (AFSSaPS) 2003] Can J Anesth, January 1, 2005; 52(1): 30 - 37. [Abstract] [Full Text] [PDF]

				I. Raad, H. Hanna, A. Huaringa, D. Sumoza, R. Hachem, and M. Albitar Diagnosis of Invasive Pulmonary Aspergillosis Using Polymerase Chain Reaction-Based Detection of Aspergillus in BAL* Chest, April 1, 2002; 121(4): 1171 - 1176. [Abstract] [Full Text] [PDF]

				C. A. Schiffer, K. C. Anderson, C. L. Bennett, S. Bernstein, L. S. Elting, M. Goldsmith, M. Goldstein, H. Hume, J. J. McCullough, R. E. McIntyre, et al. Platelet Transfusion for Patients With Cancer: Clinical Practice Guidelines of the American Society of Clinical Oncology J. Clin. Oncol., March 1, 2001; 19(5): 1519 - 1538. [Abstract] [Full Text] [PDF]