Document Detail


Complications of fiberoptic bronchoscopy in thrombocytopenic patients.
MedLine Citation:
PMID:  8404159     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
S M Weiss; R C Hert; F J Gianola; J G Clark; S W Crawford
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Chest     Volume:  104     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1993 Oct 
Date Detail:
Created Date:  1993-11-18     Completed Date:  1993-11-18     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1025-8     Citation Subset:  AIM; IM    
Affiliation:
Fred Hutchinson Cancer Research Center, Seattle.
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MeSH Terms
Descriptor/Qualifier:
Adult
Bone Marrow Transplantation*
Bronchoscopy / adverse effects*,  methods
Epistaxis / epidemiology,  etiology*
Female
Fiber Optic Technology
Hemoptysis / epidemiology,  etiology*
Humans
Irrigation / adverse effects*
Male
Prospective Studies
Risk Factors
Thrombocytopenia / complications*
Grant Support
ID/Acronym/Agency:
CA-15704/CA/NCI NIH HHS; CA-18029/CA/NCI NIH HHS; CA-47748/CA/NCI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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