Original Articles
Vol. 16 No. 1 (2024): Review Articles, Original Article, Scientific Letter, Case Reports Letter to the Editor
https://doi.org/10.4084/MJHID.2024.006

SAFETY OF BRONCHOALVEOLAR LAVAGE IN HEMATOLOGICAL PATIENTS WITH THROMBOCYTOPENIA – A RETROSPECTIVE COHORT STUDY

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: September 27, 2023
Accepted: December 10, 2023
Published: January 1, 2024
1021
Views
1210
Downloads
146
HTML
Bronchoalveolar Lavage (BAL), Thrombocytopenia, Hematological patients, BAL complications

Authors

Ivan GUR
ostyly@gmail.com
a:1:{s:5:"en_US";s:24:"Rambam Healthcare Campus";}, Israel.
Roei Tounek
Yaniv Dotan
Elite Vainer Evgrafov
Stav Rakedzon
Eyal Fuchs

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

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Bitterman R, Hardak E, Raines M, Stern A, Zuckerman T, Ofran Y, et al. Baseline Chest Computed Tomography for Early Diagnosis of Invasive Pulmonary Aspergillosis in Hemato-oncological Patients: A Prospective Cohort Study. Clin Infect Dis. 2019 Oct 30;69(10):1805–8.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.

Ethics Approval

Bronchoalveolar Lavage

How to Cite



“SAFETY OF BRONCHOALVEOLAR LAVAGE IN HEMATOLOGICAL PATIENTS WITH THROMBOCYTOPENIA – A RETROSPECTIVE COHORT STUDY” (2024) Mediterranean Journal of Hematology and Infectious Diseases, 16(1), p. e2024006. doi:10.4084/MJHID.2024.006.
Copyright (c) 2023 Ivan GUR, Roei Tounek, Yaniv Dotan, Elite Vainer Evgrafov, Stav Rakedzon, Eyal Fuchs Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.