Incidence of Bleeding Complications With Flexible Bronchoscopy in Cancer Patients With Thrombocytopenia. Issue 4 (October 2019)

• Record Type: Journal Article
• Authors: Faiz, Saadia A.; Jimenez, Carlos A.; Fellman, Bryan M.; Huk, Tauqir; Jazbeh, Sammer; Haque, Sajid A.; Morice, Rodolfo C.; Grosu, Horiana B.; Balachandran, Diwakar D.; Shannon, Vickie R.; Eapen, Georgie A.; Bashoura, Lara
• Is Part Of: Journal of bronchology & interventional pulmonology. Volume 26:Issue 4(2019)
• Publication Date: 2019-10
• Subjects: cancer -- flexible bronchoscopy -- thrombocytopenia -- safety; Bronchoscopy -- Periodicals; Lungs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Lung Diseases -- surgery -- Periodicals; Diagnostic Techniques, Respiratory System -- Periodicals; Bronchi; Bronchoscopy; Lungs -- Diseases; Periodicals; 616.23
• DOI: 10.1097/LBR.0000000000000590
• Languages: English
• ISSNs: 1944-6586

Abstract

Abstract : Background: Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/μL. Studies of bronchoscopy in thrombocytopenia are limited. Objectives: Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/μL. Method: We performed a retrospective review of all flexible bronchoscopies between June 1, 2008 and December 31, 2010. Biopsies and therapeutic procedures were excluded. The χ 2, Fisher exact, and Rank-sum test were conducted to evaluate associations of clinically significant bleeding. Results: There were 1711 patients who underwent 2053 flexible bronchoscopies. Cancer diagnosis included hematologic (61.3%) and solid organ malignancy (34.9%). Half of the bronchoscopies had moderate to severe thrombocytopenia (<100 K/μL) with the following ranges: 14.7% with 50 to <100 K/μL, 20.6% with 20 to <50 K/μL, 10.6% with 10 to <20 K/μL, 4.1% with <10 K/μL. Platelet transfusion was given in 90.6% of those with platelets <10 K/μL and 55.5% of those with platelets 10 to <20 K/μL. The nasal route for bronchoscopy was used in 92.4%. Bleeding complication rate however was 1.1% (0.2% major) and not affected by platelets. Conclusion: Bronchoscopy with lavage can be safely performed without platelet transfusion in those with platelets of ≥10 K/μL. In the absence of nasal bleeding, trauma, or deformity, the nasal route can be used for bronchoscopy.