title: Assessing the Risk of Hemorrhagic Complication following Transjugular Liver Biopsy in Bone Marrow Transplantation Recipients.
abstract: OBJECTIVE
  To determine if recipients of bone marrow transplants (BMTs) are at increased risk of hemorrhagic complications following transjugular liver biopsy (TJLB).
  
  
  METHODS
  TJLBs in BMT and non-BMT patients between January 2007 and July 2014 were reviewed. Patient demographic and pre- and postprocedural laboratory data were reviewed. Mean platelet count and International Normalized Ratio were 174,300 × 10(3)/µL ± 107.3 (standard deviation) and 1.2 ± 0.4, respectively, for BMT recipients, compared with 88,100 × 10(3)/µL ± 70.9 and 1.2 ± 0.5, respectively, for non-BMT. Patients in whom hemoglobin level decreased by > 1 g/dL and/or required transfusion within 15 days of TJLB were reviewed to determine the presence of a biopsy-related hemorrhagic complication.
  
  
  RESULTS
  A total of 1,600 TJLBs in 1,120 patients were analyzed. Of these, 183 TJLBs in 159 BMT recipients and 1,417 TJLBs in 961 patients non-BMT patients were performed. Thirteen TJLBs were complicated by hemorrhage: five in BMT (2.9%) and eight in the non-BMT cohorts (0.6%; P < .01). Preprocedural platelet counts were within normal range (57-268 × 10(3)/µL) in all but one patient (8 × 10(3)/µL). BMT recipients had an odds ratio of 4.9 (95% confidence interval, 1.25-17.3) for post-TJLB bleeding/hemorrhage compared with those without BMTs (P < .01).
  
  
  CONCLUSIONS
  TJLB continues to be a safe procedure in the vast majority of patients. However, hemorrhagic complications occurred at a rate of 2.9% in BMT recipients, compared with 0.6% in patients without BMTs, and therefore caution should be exercised when performing TJLB in this group.
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H3630, MC 5642, Stanford, CA 95305. Electronic address: osman1423@gmail.com.
authors.forename: Osman
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H3630, MC 5642, Stanford, CA 95305.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ward
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H3630, MC 5642, Stanford, CA 95305.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Lungren
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H3630, MC 5642, Stanford, CA 95305.
authors.forename: Mohammed Ahmed
authors.initials: MA
authors.lastname: Abdelrazek Mohammed
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H3630, MC 5642, Stanford, CA 95305.
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H3630, MC 5642, Stanford, CA 95305.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H3630, MC 5642, Stanford, CA 95305.
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects*; D001803:Blood Transfusion; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006470:Hemorrhage / Q000097:blood / Q000209:etiology* / Q000628:therapy; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D066027:Transplant Recipients
chemical_list: D015415:Biomarkers; D006454:Hemoglobins