SAFETY OF BRONCHOALVEOLAR LAVAGE IN HEMATOLOGICAL PATIENTS WITH THROMBOCYTOPENIA – A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Bronchoalveolar Lavage (BAL), Thrombocytopenia, Hematological patients, BAL complications
Abstract
Background
Hospitalized hematological patients often require bronchoalveolar lavage (BAL). Paucity of evidence exists as to the potential risks in patients with very-severe thrombocytopenia (VST).
Methods
This retrospective-cohort study included adult hematological in-patients with VST, defined as platelets<20x103/μL, undergoing BAL during 2012-2021. Mechanically-ventilated patients or those with known active bleeding were excluded. Primary outcomes included major bleeding halting the BAL or deemed significant by the treating physician, need for any respiratory support other than low flow O2 or death within 24 hours. Any other bleeding were recorded as secondary outcomes.
Results
Of the 507 patients included in the final analysis, the 281 patients with VST had lower hemoglobin (Md=0.3, p=0.003), longer prothrombin-time (Md=0.7s, p=0.025), higher chances of preprocedural platelet transfusion (RR 3.68, 95%CI[2.86,4.73]), and only one primary-outcome event (death of septic shock 21h postprocedurally) - compared with 3 (1.3%) events (two bleedings halting procedure and one need for non-invasive-ventilation) in patients with platelets ≥20x103/μL (p=0.219). Risk of minor, spontaneously resolved bleeding was higher (RR=3.217, 95%CI[0.919,11.262]) in patients with VST (4.3% vs 1.3%, p=0.051). No association was found between any of the complications recorded and preprocedural platelets, age, aPTT, PT, hematological status, or platelet transfusion.
Conclusions
This data suggests BAL to be safe even when platelet counts are <20x103/μL.
Downloads
Abstract 710
PDF Downloads 1060
HTML Downloads 90
References
2. Kim SW, Rhee CK, Kang HS, Lee HY, Kang JY, Kim SJ, et al. Diagnostic value of bronchoscopy in patients with hematologic malignancy and pulmonary infiltrates. Ann Hematol. 2015 Jan;94(1):153–9.
3. Choo R, Naser NSH, Nadkarni NV, Anantham D. Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates. BMC Pulm Med. 2019 Feb 26;19(1):51.
4. Uruga H, Sato T, Nishida A, Uchida N, Tsuji M, Moriguchi S, et al. Safety of bronchoscopy in patients with malignant hematologic disorders. BMC Pulm Med. 2020 Sep 11;20(1):243.
5. Kaur R, Alolaiwat AA, Ritz E, Mokhlesi B, Vines DL. A new index, Respiratory Insufficiency index and Modified Early Warning Scores predict extubation failure. Can J Respir Ther. 2023 May 18;59:117–22.
6. Facciolongo N, Patelli M, Gasparini S, Lazzari Agli L, Salio M, Simonassi C, et al. Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies. Monaldi Arch Chest Dis. 2009 Mar;71(1):8–14.
7. Faiz SA, Jimenez CA, Fellman BM, Huk T, Jazbeh S, Haque SA, et al. Incidence of bleeding complications with flexible bronchoscopy in cancer patients with thrombocytopenia. J Bronchology Interv Pulmonol. 2019 Oct;26(4):280–6.
8. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013 Aug;68 Suppl 1:i1–44.
9. Mohan A, Madan K, Hadda V, Tiwari P, Mittal S, Guleria R, et al. Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations. Lung India. 2019 Jul;36(Supplement):S37–89.
10. Folch EE, Mahajan AK, Oberg CL, Maldonado F, Toloza E, Krimsky WS, et al. Standardized definitions of bleeding after transbronchial lung biopsy: A delphi consensus statement from the nashville working group. Chest. 2020 Jul;158(1):393–400.
11. Bo L, Shi L, Jin F, Li C. The hemorrhage risk of patients undergoing bronchoscopic examinations or treatments. Am J Transl Res. 2021 Aug 15;13(8):9175–81.
12. Cefalo M, Puxeddu E, Sarmati L, Paterno G, Fontana C, Nasso D, et al. Diagnostic performance and safety of bronchoalveolar lavage in thrombocytopenic haematological patients for invasive fungal infections diagnosis: A monocentric, retrospective experience. Mediterr J Hematol Infect Dis. 2019 Nov 1;11(1):e2019065.
13. Jacomelli M, Margotto SS, Demarzo SE, Scordamaglio PR, Cardoso PFG, Palomino ALM, et al. Early complications in flexible bronchoscopy at a university hospital. J Bras Pneumol. 2020 Jun 1;46(4):e20180125.
14. Nandagopal L, Veeraputhiran M, Jain T, Soubani AO, Schiffer CA. Bronchoscopy can be done safely in patients with thrombocytopenia. Transfusion. 2016 Feb;56(2):344–8.
15. Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, et al. Platelet transfusion for patients with cancer: american society of clinical oncology clinical practice guideline update. J Clin Oncol. 2018 Jan 20;36(3):283–99.
16. Shi Y, Zhang G, Ma C, Xu J, Xu K, Zhang W, et al. Machine learning algorithms to predict intraoperative hemorrhage in surgical patients: a modeling study of real-world data in Shanghai, China. BMC Med Inform Decis Mak. 2023 Aug 10;23(1):156.
17. Zhou G-W, Zhang W, Dong Y-C, Huang H-D, Hu C, Sun J, et al. Flexible bronchoscopy-induced massive bleeding: A 12-year multicentre retrospective cohort study. Respirology. 2016 Jul;21(5):927–31.
18. Costa A da S, Scordamaglio PR, Suzuki I, Palomino ALM, Jacomelli M. Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies. Einstein (Sao Paulo). 2018 Nov 8;16(4):eAO4380.
19. Hardak E, Fuchs E, Leskes H, Geffen Y, Zuckerman T, Oren I. Diagnostic role of polymerase chain reaction in bronchoalveolar lavage fluid for invasive pulmonary aspergillosis in immunocompromised patients - A retrospective cohort study. Int J Infect Dis. 2019 Jun;83:20–5.
20. Shimoda M, Tanaka Y, Morimoto K, Abe T, Asaga R, Nakajima K, et al. Analysis of predicted factors for bronchoalveolar lavage recovery failure: An observational study. PLoS ONE. 2022 Sep 30;17(9):e0275377.
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers. Authors will grant copyright of their articles to the Institute of Hematology, Catholic University, Rome . No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.