title: Bronchoscopy can be done safely in patients with thrombocytopenia.
abstract: BACKGROUND
  Prophylactic platelet (PLT) transfusions are often administered to patients before bronchoscopy or bronchoalveolar lavage (BAL) to prevent bleeding. There is a paucity of data to validate this approach, with a commonly suggested PLT transfusion threshold of fewer than 50 × 10(9) /L, largely based on expert opinion. We conducted a retrospective study on the incidence of bleeding complications in patients with thrombocytopenia undergoing bronchoscopy.
  
  
  METHODS
  We identified 150 consecutive patients with PLT counts of not more than 100 × 10(9) /L who underwent bronchoscopy and/or BAL from January 2009 to May 2014 at our institution. The British Thoracic Society (BTS) guidelines were used to categorize bleeding associated with bronchoscopy.
  
  
  RESULTS
  Infection (40%) was the primary indication for bronchoscopy with BAL. Fifty-eight of 89 (65%) patients with baseline PLT counts of not more than 50 × 10(9) /L received prophylactic transfusions compared to 8% of those with PLT counts of more than 50 × 10(9) /L. The PLT count did not increase to more than 50 × 10(9) /L in many patients who received transfusions. Seventy-two patients had counts of less than 50 × 10(9) /L at the time of bronchoscopy, with 15 patients having counts of less than 20 × 10(9) /L. Only one patient with a PLT count of 61 × 10(9) /L had bleeding that required continuous suctioning but then resolved spontaneously (termed "mild bleeding" by BTS criteria). Bloody lavage that resolved spontaneously without continuous suctioning (termed "no bleeding" by the BTS criteria) was observed in nine (6%) patients.
  
  
  CONCLUSIONS
  The very low incidence of bleeding complications from bronchoscopy with or without BAL even in patients with PLT counts of not more than 30 × 10(9) /L (no episodes of clinically significant bleeding in 35 patients) demonstrates that bronchoscopy can be done safely in patients with severe thrombocytopenia.
authors.affiliation: Division of Hematology and Medical Oncology, Karmanos Cancer Institute.
authors.forename: Lakshminarayanan
authors.initials: L
authors.lastname: Nandagopal
authors.affiliation: Division of Hematology and Medical Oncology, Karmanos Cancer Institute.
authors.forename: Muthu
authors.initials: M
authors.lastname: Veeraputhiran
authors.affiliation: Internal Medicine.
authors.forename: Tania
authors.initials: T
authors.lastname: Jain
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Ayman O
authors.initials: AO
authors.lastname: Soubani
authors.affiliation: Division of Hematology and Medical Oncology, Karmanos Cancer Institute.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Schiffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000601:surgery*