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


METHODS
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.


METHODS
A single BMT center.


METHODS
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).


METHODS
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.


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.
Weiss
S M
SM
Fred Hutchinson Cancer Research Center, Seattle.
Hert
R C
RC
Gianola
F J
FJ
Clark
J G
JG
Crawford
S W
SW
D000328:Adult; D016026:Bone Marrow Transplantation; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D004844:Epistaxis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005336:Fiber Optic Technology; D006469:Hemoptysis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000150:complications*